Which Approach Should Be Applied in Rhinoplasty: Open or Endonasal?

Endonasal rhinoplasty is a closed-type surgical approach, whereby any incisions are placed in the interior of the nose. Even though the surgeon still incises almost 50% of the interior nostril, the closed approach means that no scar will be seen from the outside of the nose. This is an advantage of this approach. Some open rhinoplasty defenders say that it comes at the cost of the limited visibility afforded by highly constricted operative openings, which renders the operation arduous, and putting the nasal skin back in place is challenging, but this is not true. The incisions on each side are disconnected. In addition, endonasal rhinoplasty has the advantage of keeping some natural attachments in their position, so it will be easier and safer to finalise the surgical procedure. In contrast, open (i.e. external) rhinoplasty employs an incision across the columella (i.e. transcolumellar) that joins the incisions made on both sides. Although this means an incision about 4–5 mm long will be visible externally, it does allow the skin to be folded backwards along the longitudinal axis of the nose. This is somewhat akin to opening a car bonnet to show the engine. The lower nasal framework can then be visualised in its entirety. Open rhinoplasty is thus characterised by better operative exposure achieved by having the transcolumellar incision but having the risk of visibility of skin scar at the middle of the face. In this chapter, both open (external) and endonasal rhinoplasties are discussed.