Rhinoplasty, commonly known as a nose job, is a surgical procedure designed to alter the shape and size of the nose to improve its appearance or function. It can address concerns like a prominent dorsal hump, a wide bridge, or a bulbous tip, aiming to create better facial harmony. The procedure involves reshaping the underlying bone and cartilage. Closed rhinoplasty is a specific approach that focuses on minimizing external incisions and visible scarring.
Defining the Closed Approach
The defining characteristic of a closed rhinoplasty, also referred to as endonasal rhinoplasty, is the placement of surgical incisions entirely within the nostrils. The surgeon makes all necessary cuts through the mucosa lining the inside of the nose, ensuring no external incisions are visible after the procedure. This technique avoids the small incision across the columella, the narrow strip of tissue separating the nostrils, which is a feature of the open approach. Because all incisions are hidden internally, the closed method results in a scar-free nose on the outside. This method is considered less invasive than the alternative technique, as it requires less extensive lifting of the nasal skin from the underlying framework.
The Surgical Process
Once the internal incisions are created within the nostrils, the surgeon carefully separates the soft tissues and skin from the bone and cartilage underneath. This separation, performed through the narrow internal openings, allows the surgeon to access the nasal framework. Specialized, long instruments are then used to perform necessary modifications, which may include trimming or repositioning cartilage, reshaping the nasal bones, or removing a dorsal hump. For instance, a surgeon might use a rasp to smooth down a bony hump or perform precise osteotomies to narrow the nasal bridge.
The closed approach relies on the surgeon’s ability to manipulate the nasal structure without direct visual exposure, often referred to as a “blind” technique for certain maneuvers. For changes to the nasal tip, techniques like cartilage delivery may be used, where the lower lateral cartilages are momentarily brought out through the nostril incisions, manipulated, and then placed back. Cartilage grafts, often harvested from the patient’s nasal septum, can also be inserted through these internal incisions to add support or volume. After the reshaping is complete, the internal incisions are closed with dissolvable sutures.
Recovery and Post-Operative Care
The recovery experience following a closed rhinoplasty is characterized by a relatively shorter initial downtime compared to the open method. Immediately following the procedure, patients experience swelling and some bruising, primarily around the nose and under the eyes. Swelling usually peaks in the first few days and gradually subsides, with most patients returning to work and light activities within one week.
An external nasal splint or cast is applied and typically removed after about seven days to stabilize the altered structures while the tissues mend. Internal splints or packing may also be used temporarily to support the septum and control bleeding. Though initial swelling decreases significantly in the first month, residual swelling can persist for several months, particularly in the nasal tip. Final results become apparent after six to twelve months. Avoiding strenuous activity and contact sports is necessary for several weeks to prevent injury to the healing nose.
Closed Versus Open Rhinoplasty
Visualization and Access
The choice between the closed and open techniques depends on the complexity of the desired changes and the surgeon’s preference. The primary difference lies in visualization; closed rhinoplasty offers limited access and an indirect view of the underlying structures. Conversely, the open technique uses an additional incision across the columella, allowing the skin to be lifted and providing the surgeon with a direct, comprehensive view of the entire nasal anatomy.
Suitability and Recovery
This difference in access directly impacts the degree of structural work that can be performed. Closed rhinoplasty is best suited for patients requiring minor to moderate adjustments, such as smoothing a dorsal hump or slight tip refinement. The open approach, with its superior visualization and control, is preferred for more complex cases, significant tip reconstruction, or revision surgeries. Operating time is often shorter with the closed technique because it avoids the external incision and the time needed to lift and re-drape the skin. While the closed method eliminates external scarring, the open technique’s columellar scar is usually small and heals to be inconspicuous.