Primary Rhinoplasty – open versus closed ?

The term primary rhinoplasty refers to rhinoplasty performed for the first time on a patient, whether for cosmetic or functional reasons. This is in contrast to secondary (revision) rhinoplasty, which means that the patient has had one or more previous rhinoplasties.

Generally, primary rhinoplasty is undertaken by removing excess bone and cartilage from the bridge and/or the tip of the nose. The procedure can address the shape of the nose and can sometimes address breathing difficulties. 

Surgery on the structure of the nose is performed by working beneath the covering skin of the nose, either by a “closed” approach, working only through the nostrils (avoiding incisions on the outside of the nose), or, more commonly, via an “open” approach, which uses a tiny incision on the underside of the nose. 

The open approach essentially means the surgeon can actually see all the structures that need to be altered rather than just visualise them via a closed approach. For this reason, and for the increased versatility the approach can offer, it has become the most common approach to rhinoplasty. 

In primary rhinoplasty via an open approach, once all the nasal framework has been altered, the skin is repositioned over the altered structure. Changes may be subtle or more noticeable, depending on each patient’s preferences and needs. Before your procedure, you will have a consultation with Mr Greensmith before surgery with the use of the 3D Vectra Digital Camera (see under 3D Vectra).

Mr Greensmith takes time in an extended rhinoplasty consultation to listen to the needs and preferences of individual patients, but at the same time, his experience in rhinoplasty allows him to point out possible limitations that a patient may face in achieving exactly what they want in rhinoplasty. Having realistic expectations for the results of surgery is important. 

Factors that will need to be considered for each patient include skin texture and thickness, previous injuries, facial proportions (chin and forehead profiles) and individual healing/scarring. For example, skin that is particularly thick may influence the results of the procedure. No one rhinoplasty or patient is the same. Managing expectations for the results of the procedure, Mr Greensmith will explain the possible limitations of the procedure and what patients can expect.