Advantages of open rhinoplasty
The advantages of open rhinoplasty are as follows:
– Allows better control of the final result
– Allows for more appropriate tip treatment
– The tip can be strengthened in a more predictable way.
A caveat must be made regarding the technique called Delivery. This is an approach that is similar to the open approach but without making the columellar incision. This variant is used by some surgeons to avoid skin incision. We continue to see the Delivery technique as difficult to deal with symmetry.
Disadvantages of open rhinoplasty
The most important disadvantage of an open rhinoplasty is that the knowledge of the surgical technique by the surgeon requires more training than that required by the closed technique. This forces the surgeon to specialize specifically in this type of surgery.
The control of the tip in open surgery is greater. Some patients state that they have no need to make any changes to the nasal tip because their problem is only on the back (and not the tip).
It is important to clarify that the modifications on the back directly affect the tip. Therefore it is false to believe that if we focus on modifying the nasal dorsum only by closed rhinoplasty and we do not pay attention to the tip, it will not be modified. In most cases, the nasal tip requires some “stabilization,” if not more, to maintain the original position. This stability can be granted through the use of a columellar stem (autologous cartilaginous support, obtained from the nasal septum itself). Therefore, the control of the position, shape, and strength of the nasal tip is basic when facing a rhinoplasty.
The columellar incision is a small 4-mm cut made in the region of the skin called the columella (middle spine of the nose). This incision rarely leaves any noticeable scar, and in the event that such a situation occurs, it can be resolved with a minor surgical retouch.
Tip edema is another event that occurs more frequently after open rhinoplasty than after closed rhinoplasty. The immediate consequence is that the nasal tip looks more rounded. As time passes, this edema resolves, and the surgical result becomes more evident. After 3-6 months, the edema is completely reabsorbed. Likewise, whatever the rhinoplasty technique used, the nose subtly modifies its shape for one or two years after surgery.
In conclusion, open rhinoplasty offers the surgeon the advantage of being able to provide the patient with a more precise solution both in a complex nose and in a simple hump or crooked nose.