Abstract: A New Modified Closed-Open Approach as Part of a Graduated and Integrative Approach to Rhinoplasty

Abstract

BACKGROUND: Open versus closed approach in rhinoplasty is a frequently debated topic in aesthetic plastic surgery.1–3 Although good results can often be achieved with either technique, both have unique advantages and disadvantages. We present a new modified closed-open approach employed in selected cases that encompasses features of both. METHODS: The surgical approach is described in detail followed by clinical examples. Indications and limitations are discussed. The procedure begins as a closed approach through an intracartilaginous incision allowing cephalic trimming of the lateral crura and dorsal rasping and/or excision. Patients requiring extensive nasal tip maneuvers are dealt with exposure of the alar cartilage framework through a transcolumellar/limited marginal incision to provide adequate exposure of the alar cartilages as well as easy access to the septum. In our hands this approach is easy and expeditious. It requires less tip dissection, and therefore avoids the prolonged postoperative edema associated with open or extended closed tip delivery approaches. CONCLUSION: The modified closed-open technique circumvents the limitations of the closed approach by providing good exposure of the tip and septum without incurring the shortcomings of the open approach. In selected cases, it provides the surgeon with the opportunity to combine the advantages of both techniques. DISCLOSURE:No disclosures REFERENCES: 1. Daniel RK. Rhinoplasty: The First 100. In: Daniel RK, ed. Rhinoplasty. 1st ed. Boston: Little Brown; 1993: 321–80. 2. Tebbetts JB. Open and closed rhinoplasty (minus the “versus”): analyzing processes. Aesthet Surg J. 2006;26:456–9. 3. Perkins SW. The evolution of the combined use of endonasal and external columellar approaches to rhinoplasty. Facial Plast Surg Clin North Am. 2004;12:35–50.