Rhinoplasty can be performed either “open” or “closed”. Dr. Neavin uses both approaches depending on the goals and plan.
Open procedures will allow better visualization of the tip area and allow for some skin defatting to help refine the nose. The open approach uses an incision in the columella (tissue between nose). The scar that results from this is almost always not visible. The open approach may result in longer swelling.
In a closed approach, the tip is not visualized unless one performs a cartilage delivery technique. However, even with this modification of a closed rhinoplasty, less precise tip work can be conducted. And, one can’t easily de-fat the nose without opening it. The only real advantage to a closed rhinoplasty is no potential scar on the columella and less post-operative edema.
For cases where the tip needs no refinement, and the majority of the surgery is focused on a hump, the closed approach is often the best approach. If tip work or defatting is involved, then the nose is almost always opened.
In cases of revisions, the nose may be open or closed depending on the correction desired.
The surgery is performed under general anesthesia and can take up to three hours. Often, fat grafting and chin augmentation is performed during a rhinoplasty better to frame the new centerpiece of the face. Other combinations commonly performed include lip lift or lip augmentation in women and neck lift in men.
Sometimes, cartilage is taken from the nose (septum or lower later cartilages) and used for either nasal support (as is the case with a columellar strut) or cosmetic grafting (such as a tip graft to refine the tip) or spreader grafts to improve the shape of the middle of the nose.