Is it true that open nose surgery takes longer to heal? Does it cause permanent scarring? Is the post-operative recovery more prolonged and troublesome? Will the nasal tip remain stiff, swollen, and numb for a long time? These are among the most frequently asked questions about open rhinoplasty. And there are many good reasons for these questions. In recent years, the external technique has acquired a not always positive reputation, paradoxically because of its main advantages. The open view of the nasal structures makes open rhinoplasty surgery apparently less complex than endonasal or closed rhinoplasty. So, even less experienced surgeons have found the courage to venture into the difficult task of reshaping the sophisticated anatomy of such a delicate organ. Unfortunately, the results are not always satisfactory and not always meet patients expectations.
Nevertheless, by itself, external rhinoplasty is in no way “inferior” to other rhinoplasty approaches. On the contrary, in experienced hands, it can lead to results of great aesthetic harmony. Moreover, it is a reasonable choice in complex revision rhinoplasty cases where challenging reconstruction procedures are needed. However, even in complex revision cases, the open approach is not a mandatory choice as finest results can be obtained by advanced endonasal (closed) techniques. With all these advantages, external rhino-septoplasty nevertheless has several drawbacks that may lead a surgeon to choose closed or intranasal techniques.
Let’s focus on these drawbacks:
- First of all, it leaves a columellar scar. However, the risk of visible scar on the columella is significantly reduced in the hands of experienced surgeons even if the healing process is never entirely predictable.
- Secondly, the possible swelling of the tip can persist for a long time inducing formation of fibrous tissue resulting in poorly defined contours of nasal tip and dorsum.
- Finally, the recovery time is generally longer if compared to closed rhinoplasty.
However, structural rhinoplasty has had the great merit to allow nasal surgeons to improve the outcomes of both complex revision rhinoplasties and nasal reconstructions after trauma, tumor resection or due to malformations.