Q. Should I have an open rhinoplasty or a closed rhinoplasty?
A. By asking that question you feel like you have an option, although in most cases you don’t.
I’ve been practicing more than 30 years and I have seen the number of surgeons who can do both types of rhinoplasty procedures plummet. Due to the complexity of nose surgery, it is easier for the surgeon to do an open rhinoplasty. The training in closed, or endonasal rhinoplasty, has been limited, resulting in most plastic surgeons performing only the open approach.
So what is the difference between the two approaches?
The closed approach is done with no external incisions and is done through the nose. It limits the damage and/or change to the tip and can essentially be performed on most patients.
The open approach makes an incision underneath the nose to elevate all the skin, dissect through the nasal structures and use multiple graphs throughout the nose tip and body. The problem is that many inexperienced rhino plastic surgeons use this approach because they feel it’s easier and they put multiple graphs throughout the nose.
But grafting the nose creates forces that, post-surgery, often will make the nose crooked or make the nose feel unnaturally hard. I
In experienced hands, this is a good approach for patients who have thick tips, are having reconstruction or want a well-defined tip. For the average nose surgery, I don’t feel this approach is appropriate.
In fact, patients often get the wrong operation because of the lack of experience of the average surgeon. I recently saw a patient who had had two prior rhinoplasties. The first rhinoplasty lasted eight hours and the second rhinoplasty lasted three hours. After 11 hours of surgery, the patient had a nose that had multiple graphs, was still big and did not meet her expectations.
Because many doctors are now performing procedures in their offices and in surgical centers not associated with a hospital, there is minimal to no oversight as to what the surgeons are doing.
So, here are the questions you should ask your surgeon to determine if he or she is the appropriate one for you:
▪ How long does the surgery take? If this is your primary rhinoplasty, it should not take more than three to four hours, and usually one to two hours is average.
▪ Do you image patients to determine what they want?
By asking that question, your doctor will know better whether he or she can meet your expectations and if your expectations will be met by their surgery.
▪ Will you be using rib graft and or other grafting material in my nose? In my opinion, rib graft should not be used in any primary rhinoplastic procedure unless there was a congenital deformity (birth defect).
Rib graft is often very hard, tends to warp and should be used by only experts. Harvesting of a graft can leave permanent scars on the chest.
Doctors who are doing fewer than 50 rhinoplasty procedures a year should not be doing this procedure. Multiple cartilage grafting is often not necessary.
▪ What is your revision rate?
This is important to determine because you might be one of those people who will need a revision. Revision rates should not exceed 10 percent.
▪ And if you do need a revision, does the doctor charge for that revision and for the operating room fee and anesthesia?
These are questions that are important to ask prior to having your surgery. Every surgeon will have results that may not reach the expectation of the patient or the doctor and may need to do a revision operational . A well-informed patient is a much happier patient.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at Cwolf@miamiplasticsurgery.com