Rhinoplasty, commonly referred to as a nose job, is a surgical procedure designed to alter the shape of the nose for either aesthetic improvement, functional enhancement, or both. This surgery involves modifying the underlying bone, cartilage, and soft tissues to achieve a desired contour or improve airflow. Surgeons can employ one of two primary methods to access and reshape the nasal structure: the closed (endonasal) approach or the open approach. The technique selected depends entirely on the complexity of the changes required and the surgeon’s preference for visualization and control.
Defining the Open Approach
The defining feature of an open rhinoplasty is a small, external incision across the columella, the narrow strip of tissue separating the two nostrils. This incision is typically shaped like an inverted V or W, known as a transcolumellar incision, and is connected to incisions inside the rim of each nostril. The surgeon then lifts the skin and soft-tissue envelope away from the underlying bony and cartilaginous framework. This maneuver fully exposes the entire nasal anatomy, from the nasal tip cartilages to the bridge and the septum. The primary advantage of this technique is the direct visualization it offers, allowing for the most precise structural assessment and manipulation.
Steps During the Procedure
Once the nasal framework is exposed, the surgeon modifies the bone and cartilage. This often involves reshaping the lower lateral cartilages that form the nasal tip, which may be trimmed, repositioned with fine sutures, or supported with grafts. If a dorsal hump requires reduction, the surgeon removes or files down excess bone and cartilage from the nasal dorsum. For significant narrowing, an osteotomy (controlled breaking and resetting of the nasal bones) may be performed to move the bones inward and achieve a slimmer profile.
Many open rhinoplasties require cartilage grafts for long-term structural support, especially in the nasal tip and mid-vault. Cartilage is most commonly harvested from the nasal septum because it is readily available and strong. For substantial augmentation or reconstruction, cartilage may be taken from the ear or, less frequently, the rib. The procedure concludes when the surgeon redrapes the skin envelope and meticulously closes the columellar incision with fine sutures.
When Surgeons Choose the Open Method
The open approach is generally the preferred method for cases requiring extensive structural change or significant anatomical correction. The superior visualization afforded by the technique is invaluable when performing complex tip refinement, where millimeter adjustments to the cartilage domes are necessary for a crisp, stable result. This direct view ensures that grafts are placed and secured with the highest degree of accuracy. Surgeons often select the open method for revision rhinoplasty, as scar tissue and distorted anatomy make direct visualization paramount for rebuilding the nasal structure. Furthermore, the open approach provides the necessary access and control to effectively correct significant functional issues, such as a severely deviated septum or collapsed nasal valves, which often require robust cartilage grafting for reconstruction.
Post-Operative Healing and Scar Management
Initial recovery involves significant swelling and bruising around the eyes and nose, which typically peaks within the first 72 hours. A splint placed externally on the nasal bridge is usually removed by the surgeon within the first week after surgery. While the most noticeable swelling subsides rapidly over the first few weeks, residual puffiness, especially in the nasal tip, can persist for a long time.
The nasal tip is the last area to resolve swelling, sometimes taking a year or more to reveal the final contour. This prolonged swelling is partially due to the surgical dissection necessary to lift the skin envelope during the open approach. The external incision across the columella heals quickly, with the sutures typically removed within five to seven days.
Although an open rhinoplasty results in a small external scar, it is placed in a location where it tends to blend into the natural shadow of the nose. Over the first six to twelve months, this scar matures, fading from a reddish line to a thin, subtle white line that is often barely perceptible. Scar management protocols, such as gentle massage and the application of silicone sheets or gels, are often recommended by the surgeon to optimize the final appearance.