Mr Alwyn D'Souza - Consultant Otolaryngologist
The growth in skill and training and as well as technology available today has resulted in two basic techniques:
- The open rhinoplasty technique
- The closed rhinoplasty technique
The technique employed depends on, the surgeons training and the desired outcome. Open rhinoplasty involves a cut in the midline partition of the nose called the columella and the rest of the incisions are inside the nose. The main advantage of open rhinoplasty technique is excellent exposure of the nasal tip as well as the rest of the nose. This gives the surgeon complete control over the procedure, particularly tip modification and reconstructing the nasal valve etc.
Closed rhinoplasty is where all the cuts are made inside the nose. This is a procedure where a combination of "see and feel" plays an important part. It is almost like doing an operation through a keyhole. Generally speaking all UK surgeons are trained in closed technique, whilst fewer are trained in open technique.
Mr Rajan Uppal - Consultant Plastic & Cosmetic Surgeon
Nose surgery is usually done with the patient asleep, although small changes can be undertaken under local anaesthetic or with fillers injections. I use keyhole surgery to avoid scars under the nose which is called "closed rhinoplasty". This requires more experience as most surgeons use the "open" technique which unfortunately gives you a scar under the nose.
Closed rhinoplasty incisions are made inside the nose in this way where they are invisible and scar free. To reduce the bump on the nose, certain amounts of bone and cartilage are removed or rearranged to provide a newly shaped nose. If the patient has a deviated septum (cartilage and/or bone causing obstruction inside the nose), septal surgery, called septoplasty, is also performed. The incision is placed entirely inside the nose. The septoplasty removes portions of cartilage and/or bone that are causing the obstruction. The incisions are closed with fine sutures, followed by placement of a splint to the outside of the nose. The splint helps retain the new shape while the nose heals.
Mr Francis Peart - Consultant Plastic & Reconstructive Surgeon
There are many delicate surgical steps involved, each chosen to alter each anatomical element as the situation demands. Most commonly, a nasal hump is removed and a tip lifted or refined, by both removal of the excess bone and cartilage, and the recreation of a stable nasal architecture by direct repositioning and suturing. Commonly, the nasal bones need controlled fracturing. The surgery may involve more complex manoeuvres, such as nose straightening if a deviation is present, or septal correction if there is an obstruction to breathing. Not infrequently, cartilage grafts are required to build an aesthetically pleasing framework, and these may need to be taken from the septum, the ear, or in more complex cases, the ribs.