Open Versus Closed Ethnic Rhinoplasty
This figure demonstrates one segment of Dr. Slupchynskyj's advanced Ethnic Open Rhinoplasty technique. In order to "open" the nose, an incision has been made in the columella (the small strip of skin between the nostrils) and the nose has been pulled back to access the Upper and Lower Lateral Cartilages. Open Rhinoplasty, when performed properly, involves little if any bleeding as it is performed in the mostly avascular (bloodless) sub SMAS layer of tissue. This is important because the amount of bleeding during the procedure correlates with the amount of swelling that occurs afterward. One of the critical advantages of Dr. Slupchynskyj's Open Rhinoplasty technique is a much faster, easier healing time.
The Ethnic Open Rhinoplasty surgical technique allows for direct visibility of the nasal structures including the nasal tip, which cannot be directly visualized via the Ethnic Closed Rhinoplasty technique. As shown in the illustration above, the nasal flap is elevated, revealing the internal components of the nose to the operating surgeon. Since the nasal structures are uncovered, the surgeon has enhanced ability to access and work on them. Despite these advantages, few surgeons perform the Open Rhinoplasty technique because of the training, skill and experience required to produce successful results. The midcolumellar incision used to open the nose will sometimes be mentioned as a drawback to the Open technique. However, one needs only to see the Before and After Photos of a proficient Open Rhinoplasty surgeon to see that with meticulous technique and skill the scar is imperceptible once healed.
In the illustration above, a surgeon is shown accessing and augmenting the nose through the nostrils. This technique is called Ethnic Closed Rhinoplasty. In this technique, performed entirely through the nostrils, the surgeon makes an incision inside the nose in the space between the Upper and Lower Lateral Cartilages called the intercartilaginous area. Then, the surgeon separates the nasal tissues using a scissor, as demonstrated in the illustration above. This separation or dissection of tissue is performed blindly since the surgeon cannot see the nasal planes that he or she is working on. This lack of visibility can sometimes lead to less accuracy in augmentation when compared to Open Rhinoplasty. Less accuracy in tissue manipulation can contribute to more bleeding and therefore more swelling and pain post-operatively.
Lack of visibility and access in Ethnic Closed Rhinoplasty proves to be the main disadvantage of this technique. Since the nose remains closed, the surgeon is not able to view the entire Lower Lateral Cartilages, sometimes leading to inadequate trimming and augmentation of the dorsal septum. When this occurs, a protrusion at the caudal end of the dorsal septum is left behind, resulting in a Pollybeak Deformity. Sometimes, lack of precision during tissue dissection leads to a buildup of scar tissue in the area just above the nasal tip, also causing a Pollybeak Deformity. Pollybeak Deformities are an unnecessary but common complication of poorly performed Closed Rhinoplasty procedures.
In less complex nose surgery cases, Closed Rhinoplasty may be considered appropriate. Some patients may only require the removal of a nasal bridge hump. In those simple cases, Closed Rhinoplasty may be sufficient. More often though, better visualization and access is needed to adequately address a patient's complaints, particularly when nasal tip work is involved. For that reason, Dr. Slupchynskyj believes that Open Rhinoplasty is the superior approach.