What’s Scar— Free Rhinoplasty?

I’m often asked during patient consultations, “Is my scar going to show?” 

Many patients have friends who have had rhinoplasty, and now have a prominent scar that lies in the skin between the nostrils. This is where the nasal skin is cut in a surgical approach called an “open” rhinoplasty.

However, over the years, the idea of open rhinoplasty fell out of favor as the social stigma of a scar became more prominent.

What’s “closed” rhinoplasty?

“Closed rhinoplasty” is the other surgical approach where there are no external scars at all. It is a bit of a misnomer though. “Closed” makes it sound as if there are no cuts made, but this is wrong. All the incisions are inside the nose, and therefore aren’t visible or detectable at all. 

It sounds like this should be the way that all rhinoplasties are performed. Who wants a scar?

Well, for decades all rhinoplasty was performed in the “closed” technique. Operating through small incisions inside the nose was difficult, though. The lack of visibility in the surgery was a big deal. It limited accuracy, created asymmetries, and stifled technical innovation. The biggest problem of closed rhinoplasty was that it was all but impossible to learn. The young surgeon could not see what was going on! This was not an optimal situation for surgeons or their patients.  

Reviving “open” rhinoplasty

The 1970’s and 80’s rekindled interest in the once lost “open” approach. Because of the greater visibility, symmetry was improved, and the anatomy and function was much better appreciated.  Most importantly, the teaching and learning process and surgery results were much better.

It made technical advances like the addition of cartilage grafts for form and function much more realistic. It also led to more conservative techniques such as shaping cartilage with permanent sutures, rather than simply removing it.

What type of rhinoplasty do you perform?

I use both the “open” and “closed” approaches as appropriate.

Many rhinoplasties can be performed closed with more efficiency and more accuracy, as much less anatomy is disrupted that must be later reassembled. I reserve the open approach for three types of noses: those that are severely deviated, revision or second time rhinoplasties, and the nose with a surgically difficult tip.

When I discuss this with a patient, I explain my preference for the closed approach. But I’m the first to admit that the scar with the open approach is minimal. However, as a surgeon I can still usually see it. For my taste, I find closed rhinoplasty is much more elegant, and never betrays the secret illusion of surgery.

When it comes to the chosen technique, what matters is customizing the process for each patient’s individual concerns so we can achieve their desired aesthetic. Visit the rhinoplasty page to learn more about this procedure.