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Common Questions about Rhinoplasty

What is a closed rhinoplasty?
A closed rhinoplasty refers to a technique where incisions are made only within the nose leaving no visible scar.  With the cartilage delivery technique, the tip cartilages are pulled through the internal incision to allow some reshaping.  In other forms of closed rhinoplasty, the tip surgery is performed blindly because there is no direct visualization of the tip components.
What is an open rhinoplasty?
In an open approach, an incision is made on the columella allowing the skin to be elevated off all of the underlying tip cartilages to provide direct exposure to this area.  The open approach will allow more reshaping options such as more complex tip narrowing and de-fatting.
Why do some doctors only do open or closed rhinoplasty?
Most doctors are trained in either one of two ways and develop a particular comfort to one approach.  Dr. Neavin has experience in both open and closed approaches and tailors the approach to the patient’s desires and expectations.
What approach is better? Open or closed?
Many plastic surgeons will offer their opinion and cite reasons why one approach is better than the other.  Both open and closed rhinoplasty have their own unique advantages and disadvantages.  Whether one approach is better than the other really depends on goals and expectations.
How long will I be swollen after a rhinoplasty?
Swelling after any nose surgery may take up to a year to resolve.  While most swelling is gone within the first 6 weeks, persistent tip edema may linger.  Open rhinoplasty often results in longer swelling than closed rhinoplasty.
Why do plastic surgeons sometimes break the nose?
Nasal bones are sometimes, not always, fractured in a rhinoplasty to either narrow the upper part of the nose or to do what is called “closing an open roof”.  An open roof occurs when filing of cartilage and bone leave a gap between the bones that may be felt under the skin.  Breaking the bones and pushing them together will close the roof of this gap and also narrow the nose.  It may also be performed to correct a bone asymmetry.
Why does thick nasal skin make rhinoplasty more challenging?
Skin is generally thicker among certain nationalities such as Asian, black, hispanic, and Middle Eastern.  Thicker skin hides the underlying cartilage features and limits how much definition one can have in the tip and how thin it can be made.  Thicker skin also makes tip support more difficult.  Noses with thick skin have a higher propensity to drop after surgery.  Often, extra cartilage support is placed in the nose to add support in thick skinned patients.
What is a bulbous tip?
Bulbous tips are round and big and are a result of overdeveloped lower lateral cartilages.  The treatment is usually removal of cartilage (called a cephalic trim) and suture techniques to narrow the lower lateral cartilages.
What is a boxy tip?
A boxy tip is one that resembles a square.  Like a bulbous tip, it is the result of overdeveloped lower lateral cartilage that is corrected with cephalic trim and suture reshaping techniques.
What is a plunging tip?
A plunging tip describes the dropping of a nose with smiling.  It is a combination of cartilage position and muscle attachments to the tip of the nose.  The correction of a plunging tip is the division of the depressor nasals muscle which can be done through the nose or mouth.
What is a polly beak deformity?
A polly beak deformity is usually a complication of rhinoplasty where there is a convexity to the nose instead of a slope.  In this instance the tip is usually under tilted and weak.
What is a hanging columella?
The columella is the column of tissue between the nostrils.  Ideally, a few millimeters of the columella are visible on profile.  With a hanging columella, excess columella is visible. The treatment involves reducing the cartilage that is pushing the columella down.
What is a hidden columella?
On side view, the columella cannot be seen.  The ala can either be reduced or the the columella can be lengthened.  This type of feature is common among hispanic and African American men and women.