Endonasal and External Approaches in Rhinoplasty

A common problem a person undergoing rhinoplasty is faced with is the option of a closed versus open procedure. These terms define two surgical options, which require temporary removal of the nasal skin exposing the skeleton. Since the changes that occur to the nasal bridge affect the outer nasal appearance, the surgical method used has a direct effect on the outcomes’ quality of rhinoplastic surgery. In the closed approach (or endonasal rhinoplasty), all incisions are made within the nostril itself, which reduces any appearance of an external scar. One of the major caveats to this technique is that the nasal skin repositioning with this procedure remains difficult and the visibility is limited through the narrow incisions. Therefore, the closed rhinoplastic option lacks the surgical exposure that is associated with the endonasal option. The open (or external rhinoplasty) method requires a small nasal bridge (trans-columellar) incision to join the incisions of the right and left nostril. The hallmark of open rhinoplasty is the trans-columellar incision, which warrants increased visibility and access. Using this method, the nasal skin can be folded upward and the nasal cartilage can be better evaluated in its natural, undisturbed alignment, while minimizing unwanted cartilage alterations. While multiple features can be corrected for an unappealing nose through the closed approach, the open approach has its advantages including versatility, effectiveness, and improved accuracy that outweigh the marginal threat of a visible scar.