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Open Rhinoplasty – Should It Be the Procedure of Choice?

BR Neu. Open rhinoplasty – Should it be the procedure of choice? Can J Plast Surg 1994;1(4):166-176. Open rhinoplasty is currently recognized for its usefulness in treating complex nasal deformities. This study examines and supports the routine use of the open approach for all cosmetic nasal operations. Forty consecutive open rhinoplasties were carried out. Included were primary, secondary and post-traumatic deformities. The surgical technique is described and the results are reviewed. Precision is enhanced with the open exposure. Alar cartilages are repositioned and contoured into shape with sutures. Tip rotation and elevation are more easily controlled. Cartilage grafts are used less often and, when required, are accurately sutured into place. A learning period is needed to understand the new perspective of the exposed cartilages and the effect on the external appearance. Asymmetries are easily created, and overcorrections must be avoided. The procedure takes longer. Nasal tip hypoesthesia and edema are more pronounced. The columellar scar is well accepted. The improved results with open rhinoplasty justify it becoming the procedure of choice in the author's practice. Minor modifications of the nasal dorsum or tip are still carried out through the endonasal approach.