About the Surgery
What is Closed Rhinoplasty?
Surgery performed through the nostrils is called closed technical rhinoplasty.
What are the types of Closed Rhinoplasty?
There are 2 main groups of closed rhinoplasty.
In the 1st group, a 3-5 mm piece of the nasal wing cartilage is removed from the upper part of the nose, without seeing the nasal tip cartilages in rhinoplasty surgery. The nasal bridge is removed and the bones are narrowed. It will be over in 1-2 hours. Cartilage grafts are not used much. The results of this technique are less controlled.
In Group 2, nasal tip cartilages are delivered through the holes. Open techniques are used and nasal lights are reconstructed after the nasal bridge is removed.
Is Closed Rhinoplasty blinded?
It is very difficult to control the operation performed without seeing the nasal cartilages. In the delivery technique, all regions are made by sight. In the open technique, all cartilages are seen with a wider angle, while in the closed technique, the nasal skin and cartilages stand in front of us as a whole. The closed technique is more successful in terms of feedback such as “Let me lift a little more”, “Let me get a little more belt”, “no no, it’s upturned, let me lower it a little more”.
What are my completely personal opinions about the open-closed preference in rhinoplasty?
These opinions are my own, each surgeon has their own opinions. It is normal for surgeons to have different opinions on some issues. I am a surgeon who believes in both open and closed techniques and uses them when necessary.
As much as possible in a patient with rhinoplasty.
- Natural nose should have light and shadows.
- Like a normal nose, it should be soft. Kissing should not hurt your partner.
- There should be no drowsiness.
- After the operation, they should be able to easily squeeze their nose, blow their nose, clean their nose with their fingers and not feel pain during this time.
- There should not be any traces that his friends can understand that he had surgery.
In primary rhinoplasty, with the closed technique, the surgeon with sufficient experience can easily achieve a successful open technique result. Open technique should not be preferred for every patient.
A good closed rhinoplasty results in the same results as a good open technique rhinoplasty with less nasal tip edema.
Because closed technique rhinoplasty usually requires less cartilage grafting, L septoplasty is not needed. Textbooks say that one out of 10 patients will have surgery again. Surgeons who do this job a lot, have a nose revision probability of less than 5%, but there is still such a possibility and this possibility should always be kept in mind. In primary rhinoplasty, if the septum cartilage is removed, cartilage from the rib and ear should be removed in secondary rhinoplasty.
The problems in secondary rhinoplasty are very diverse. If the tip of the nose is very beautiful, but there are problems on the back of the nose, the problem is solved with the closed technique without touching the tip of the nose. If the open technique is preferred, the beautiful nose tip is also at risk.
If there is a problem at the tip of the nose, but not excessive, it can be used with the delivery technique.
If the tip of the nose is extremely deformed, open technique should be preferred. If the nose tip is to be reshaped with ribs or ear cartilage, the open technique is a better choice.
Opting for open technique and structural rhinoplasty for every primary rhinoplasty is like using a cannonball for every enemy. The job is done again, but more destruction is done. There is more edema and a long recovery period. The resulting nose is harder.
In nose reduction procedures, we remove cartilage and bone. The shrunken skeleton is abundant in leather and inner red skin. We cannot remove the skin, we expect it to adapt to the new nose. However. The red skins inside sometimes thicken without shrinkage and cause breathing problems. Since closed rhinoplasty is performed from areas with red skin excess, when the surgery is finished, the excess is removed before stitching. Thus, breathing problems due to excess skin do not occur.
In 2012, we wrote an article in the ASJ journal about the ligament of Pitanguy, which I call the nose tendon. This structure, called the ligament of Pitanguy, is a rubbery semi-elastic but very strong structure. It is a connection between the nose muscles and the lip muscles. With this structure, the tip of the nose is both standing and soft. In structural rhinoplasty, this system is disrupted and cartilage grafts are placed instead. Then the nose will still be standing, but it will be harder. Pitaguy described this tissue in 1960 and said to remove it or cut it. Sew for the first time, protect or shorten if necessary and gain dynamic projection (nose tip height), we were the ones who said. Thus, the possibility of loss of projection due to product tip drop is greatly reduced. Less cartilage is placed at the tip of the nose. In closed technique rhinoplasty, surgery can be performed without cutting the nose tendon. In the open technique, cutting is mandatory but can be repaired.
Knowing the principles of graft, flap, meticulous surgery, tissue nutrition and wound healing, which are the basis of plastic and reconstructive surgery, provides serious advantages in rhinoplasty surgery, which includes cartilage flap and graft techniques, of an organ consisting of cartilage, skin, mucosa, cartilage and bone.