This is one of the most confusing issues for rhinoplasty candidates. He says that the doctors who do open rhinoplasty will not stay, those who do closed rhinoplasty will stay. Well, both groups are doctors, they are not going to lie.
First of all, what is a “trace”, it is necessary to define it well. In plastic surgery, “trace” is the common name for all physical symptoms that allow an operation to be understood by an outside eye. When we say “scar” of the operation, we mean all the signs that the person has had surgery. When we say “scars” in rhinoplasty, what is often meant is incision marks due to skin or mucous incisions.
Let’s list these traces…
⦁ The tissue bridge (columella) separating the two nostrils
an incision scar of 4-6 mm in length, passing through the middle.
This scar is the entrance scar used when separating the nasal soft tissues from the skeleton in open rhinoplasty. We do not see this part of the nose when viewed from the front, so a trace here is outside of our visual attention in daily communication. Since the wound healing of this area is quite good, if it is sutured with care, the thickness of the scar here will be less than 0.5 mm. I have difficulty seeing these scars even when looking under bright surgical lights with magnifying surgical glasses on my eyes during secondary surgeries. On the other hand, if there is a level difference between the wound lips during suturing, if the very elegant tissue here is damaged by the rough technique, the scar may be evident and may need to be renewed in a second session.
⦁ The incision mark at the junction of the nasal skin and nasal mucosa on both sides of the columella.
This trace corresponds to the place where the first trace above curves from the sides towards the inside of the nose. While this scar is limited to the upper half of the columella in the open technique, when the cartilages are delivered and shaped outside in the closed technique, the scar often has to cross the columella all the way through. If the necessary care is not taken, this scar can be seen from the outside in patients who have undergone closed rhinoplasty.
⦁ The incision mark left in the groove where the wings and cheek meet in cases where the wings of the nose are reduced.
If the nostrils or wings are large and these structures need to be reduced during surgery, it is impossible to do this without leaving a scar on the skin. This scar is the most obvious of the scars left on the skin after nose surgery. If the wings are to be reduced in the open technique or in the closed technique, this trace will remain in any case.
⦁ The incision marks left on the skin by the metal bone piercings we call “osteotome”.
One of the techniques used in shaping the bones in nose surgery is to shape the bones directly over the skin with a very thin metal chisel. In this technique, which is called percutaneous osteotomy, incision scars may remain on the skin (1-2 mm) as thick as the instrument used. Since this technique is preferred by some of the physicians who perform both open and closed rhinoplasty, these scars may occur after surgery in both techniques. On the other hand, these scars will be invisible after 3-6 months of healing process.
Depending on the techniques used in open rhinoplasty surgery, all of these 4 types of scars can be seen. On the other hand, these scars heal so gently when the appropriate technique is used that an eye looking from the outside cannot see these scars unless they get very close and examine them in a very bright environment.
The issue that most people do not know is that the second, third and fourth scars can also be seen in closed rhinoplasty surgery depending on the techniques used.
Therefore, the sentence “open rhinoplasty leaves scars, but closed rhinoplasty does not” is not entirely true.
Incision scar or deformity?
If a person who does not know you and sits at the next table can understand that your nose has been operated after rhinoplasty, it means that he is doing it by following some traces. If we list the problems that give clues to the observer that the nose has been operated after the operation, the incision marks we have listed above will be at the end of this list.
The main problems that make up the appearance of the operated nose are structural defects (deformity) in the nose. Closed rhinoplasty is an operation that is more prone to post-operative structural disorders because it is performed without “seeing” the skeleton and cartilage structure in the nose. For this reason, it is unreasonable for both physicians and the majority of patients to take into account the structural defects that can be seen from the next table in order to avoid a scar that is almost impossible to see in daily life.
Due to these problems, modern closed rhinoplasty surgeons have sought ways to perform some surgical maneuvers used in the open technique with the closed technique, and hybrid (semi-open) surgical techniques have emerged. Even these can be applied effectively only in a limited group of patients, not in every patient. Since most of the surgeons experienced in rhinoplasty today can safely apply both open and closed techniques, it will definitely be to your advantage to leave the decision to your surgeon in terms of choosing the most suitable technique for you.