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Closed-Open Rhinoplasty with Extended Lip Dissection: A New Concept and Classification of Rhinoplasty

Background: Open rhinoplasty represents a surgical technique that has increased in popularity during the past several decades. However, to achieve full access to the entire nasal framework, a transcolumellar incision is required. In this study, the authors present the results of a rhinoplasty technique avoiding the transcolumellar incision while offering full access to the entire osteocartilaginous framework. Methods: Twenty-four patients (17 women and seven men) with a mean age of 28.7 years (range, 21 to 49 years) were the subjects of this study. Four patients underwent secondary rhinoplasty and 20 patients underwent primary rhinoplasty. The surgical procedure comprises an alar base resection incision with thorough undermining of the anatomical area between the nasal base and the upper lip, allowing nondistorted access to the entire osteocartilaginous framework and performance of all standard rhinoplasty techniques. A transcolumellar incision is not performed. The minimum follow-up period was 12 months. Results: All 24 patients expressed a high degree of satisfaction with the surgical result achieved. Postoperative swelling and initial lip dysesthesia resolved in all cases within the first 6 weeks without any morphologic or functional sequelae. Considering different rhinoplasty approaches, a classification of the existing surgical procedures is proposed. Conclusions: The authors believe the rhinoplasty technique presented in this article is a combination of closed and open approaches. It offers excellent access to the entire osteocartilaginous framework, while preserving the columella. The proposed rhinoplasty classification may simplify and aid the surgeon in deciding among the different rhinoplasty techniques.