IV. INCISIONS AND APPROACHES

The two approaches to rhinoplasty are the endonasal or "closed" rhinoplasty (all incisions hidden inside the nose) and the external or "open" rhinoplasty (all but one small incision are inside the nose). In open rhinoplasty there is one small incision across the colu­mella (the skin between the nostrils). This incision is generally extremely difficult to see, and is only 3 or 4 mm long (Fig. 18).

Because every nose is different and has unique surgical requirements, the closed approach may be more suitable for some noses, while the open approach may be more suitable for others. There is an area of overlap—that is to say, there are some noses that may be done through either the open or the endonasal ap­proach. Some surgeons perform predominantly one approach as a result of their personal experience and training, while other surgeons are adept at both.

Fortunately, there are no major disadvantages to either approach. However, each approach has special advantages for specific situations. Because every nose is different and has unique surgical requirements, the pa‑tient should expect his or her surgeon to explain which approach should provide the best outcome. When the patient is interested, the surgeon should be willing to discuss the technical aspects of the planned surgery.

FIGURE 18. In open rhinoplasty there is one small incision across the columella (the skin between the nostrils). This incision—across the tissue between the nostrils—is generally extremely difficult to see, and is only 3 or 4 mm long. The patient shown here (a, b preoperative, c, d postoperative) had an open rhinoplasty. The incision may be seen on the postoperative base view (d).

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