Open Rhinoplasty

Dr Steve Byrd, Dallas Plastic Surgeon, discusses his publications and surgical techniques in open rhinoplasty.

Open rhinoplasty is the term used when an incision is placed across the columella to enable exposure of the nasal tip. In essence, the transcolumellar incision connects the standard intranasal incisions used in closed rhinoplasty and adds about 5 mm (1/4") of additional length to the incision. The big advantage of this approach is the wide visibility given to the nasal tip. This visibility is important because it allows direct shaping and support of the tip cartilages. The techniques that are employed in tip shaping and support have revolutionized the outcomes that are now possible in both primary and secondary rhinoplasty. Furthermore, these techniques allow for the preservation of structure which minimizes secondary deformity.

The negatives associated with open rhinoplasty relate primarily to the additional columella incision (scar) and to the fact that there is more swelling and slower healing in the nasal tip. I see the arguments over the choice of the surgical approach as somewhat ludicrous. If the open approach offers advantages in form, shaping, and stability of outcome, then by all means the small incision is justified. If an equivalent result can be achieved closed, then it is unnecessary. The scar has simply not been an objectionable feature in any of my patients and in my entire experience with open rhinoplasty, I have only revised one of the columellar incisions that I created. Certainly, I have seen bad scars but I have also seen bad closed rhinoplasties. I don't believe a rhinoplasty surgeon should be bound by a single approach. He should be able to advantage his/her patients with the full armamentarium of techniques that can provide the best possible outcome.

The above patient has ultra thin skin, short nasal bones, and very delicate midvault cartilages. Refinement of the tip is desired but modifying the tip cartilages without full control of support and shape of the tip lobule complex would be disastrous. An open rhinoplasty allowed tip modification, shaping, and control as illustrated in the surgical diagrams.