Q. I’m confused and hope you can help me. I have seen several surgeons to do my nose and now I’m even more confused. One says he only does his surgeries with the open technique, another says he only does his noses with the closed technique . What are your thoughts and what should I look for when deciding to do my nose?
A. It’s not a great idea nor comforting going into surgery when you are confused. I will try to give you some information to help you make a more informed decision. I am of the belief that in order to be a great nasal surgeon you should be able to use both techniques. Your surgeon doesn’t have to use them equally, but he/she should be able to use them when necessary.
The closed or endo-nasal technique involves making all the incisions inside the nose with all the work done through the same incisions. The open technique is done by making an external incision in the columella, the structure that separates the nostrils. The work is then done by directly observing the cartilages and doing the work in an external fashion. Both techniques are a means to an end, a successful nasal surgery.
I prefer to use the closed technique when I have a patient who has a wide nose with a bump the does not require much tip work. I also use this technique when a patient has thin skin with very little need for tip work.
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The open technique lends itself to surgery when a revision, or redo, of the tip is necessary or when a reconstruction of the tip is needed. I also use this technique to reconstruct the airway passages when too much cartilage has been removed from a previous surgery.
I can use this technique in a primary nasal surgery when I need to have access to the cartilage so that I can suture and secure the cartilage. The open technique also works well when patients need a lot of tip work when their skin is thin and when I am trying to accentuate the tip without causing a pinched- in look.
While this explanation is a very simplified one, not all surgeons know or do both techniques. The fact that they don’t do both techniques does not indicate that they are not good surgeons. Many experienced surgeons can master one technique sufficiently to accomplish a good result. My feeling is that the more options you have in your tool kit as a surgeon, the better you can take care of your patients.
Dr. Wolf is a board certified facial plastic surgeon and a partner at Miami Plastic Surgery. He can be reached at email@example.com.