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Open versus closed rhinoplasty scar versus scarless. Let’s talk about it. This has been a controversial topic since the 1990s and patients are sometimes saying, I do not want a scar on the bottom of my nose. Um, and I want you to make as much change as you can to me. And I prefer if you could do this without a scar, and then there’s some surgeons who say, I need to make a scar, so who’s right, who’s wrong. And what’s the best way of doing this. So I don’t actually think there’s a better approach scar or scarless, open or close. They’re all, they’re all kind of similar ways to address the nose. And I think you, you, as the patient to decide what you want to change your nose and what you want it to look like, and then you go to a surgeon based on their skillset and what you think they can accomplish.
So, um, I studied fortunately with some great open rhinoplasty surgeons and some great close rhinoplasty surgeons. Um, I think two of the best close rhinoplasty surgeons, um, who are, um, still operating today. And, um, it’s really important to know what each technique offers and what its limitations are closed or scarless. Rhinoplasty is an excellent approach for addressing the bridge of the nose in most patients. The benefit of a scarless approach is that you can make some, um, some nice changes to the bridge. You can do this with, um, direct visualization, him technique preservation techniques. And it’s really nice because the recovery can be quite fast and you’re not changing the variable of the tip of the nose, or at least overly changing it. Um, you can also make minor modifications, uh, for patient’s tip with a scarless or, uh, closed rhinoplasty. Um, one of the nicest techniques to do this is Finese rhinoplasty, um, and with other S with closed rhinoplasty where this can be done, however many patients who are coming in do not have such straightforward and I’ll use that word straightforward anatomy.
And so, and they want their nose to look a specific way. You’ll see patients. Many of my patients have these subtle deviations that are present, especially when they smile. Many who have seen me before surgery want to make their nose dejected, um, not overly lifted, but not, um, but with enough support. So when you have patients changing multiple variables of the nose and wanting a specific look with the nose and, um, a highly, uh, change de defined tip, uh, where you’re making big volume metric changes in the nose. In my opinion, the only way of doing this is through an open approach because a closed rhinoplasty approach is gonna be limited on what you can accomplish, um, and still provide support and stability to the patient’s nose. So both techniques are great. It’s just a matter of what you’re hoping to achieve as a patient. If you have a highly deviated nose, um, you may be able to accomplish this with a closed approach, but you have to look at where the deviations at some deviations can be done, closed effectively with a, um, uh, but
Many deviations where the internal aspects of it, the boney deviation there’s multiple aspects that are deviated might actually benefit from an open approach. Um, instead, um, for patients who are wanting major reductive changes in their nose, oftentimes an open approach is better and revision rhinoplasties. Again, if you’re making a major change to their nose, probably better do an open, although if you’re making small changes closed. So both techniques are great. Go to a surgeon who can do both, and then let them decide with you on based on your aesthetic.