Open Rhinoplasty

The open rhinoplasty has become a popular operation but it also has the size reduction limits of the traditional operation. The name implies a more open exposure of the nasal skeleton by placement of an additional incision across the columella  1  and complete elevation of the skin from the tip cartilages.

The nose tip  2  can be the most difficult nasal structure to modify in a pleasing way. Complete exposure of the cartilages allows new techniques such as folding the cartilages with permanent sutures and accurate reduction of asymmetrical cartilages for greater symmetry.

Tip refinement usually means converting a broad, featureless nose tip into a more angular and pointed shape. In the past, this was often attempted in the closed ("Traditional") operation by removal of much of the tip cartilages. Experience with the open operation has taught surgeons to be more conservative. It is apparent that retention of the tip cartilage is necessary for skin support, preventing the slumping of the skin into a featureless shape.

The open method is particularly useful when extra cartilage is required in the nose tip to increase projection. Cartilage grafts can be sutured to the existing cartilage framework and shaped very accurately. This is a very effective method but it should not be over done.

Delicate cartilage graft "struts" can be fitted and sutured within the columella to strengthen and straighten this part of the nose. A moderate amount of projection of the columella can be achieved in this way. (If a big projection is required it is usually necessary to insert a large cartilage graft, such as that taken from the rib cartilage, behind the columellar base.)

The disadvantages of the open rhinoplasty are the resultant scar across the surface of the columella  1  , more prolonged swelling of the nose tip  2 , a loss of control of the skin and weakening of the tip when the skin is separated from the tip cartilages and the longer operative time which will incur higher fees and hospital charges.

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