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Preservation Rhinoplasty: Open or Closed?

Authors:
Aaron M Kosins

Aesthet Surg J 2022 Apr 20. Epub 2022 Apr 20.

Department of Plastic Surgery, University of California, Irvine, Irvine, CA.

Background: Preservation rhinoplasty (PR) is an evolving philosophy.

Objectives: The open approach was used initially, but the author felt a closed approach might be of benefit in certain patients.

Methods: One hundred sixty-two primary rhinoplasty cases were studied retrospectively between January and July 2020. One hundred cases had at least 1 year of follow-up. Patients had follow-up at 1 week, 1 month, 3 months, and 1 year after surgery. Technical details were recorded including dissection planes, preservation of the dorsum (DP) versus component reductions, surface versus foundational DP techniques, and open versus closed approach.

Results: One hundred patients had at least 1 year of follow-up. Fifty-six patients underwent an open approach, and 44 a closed approach. Eighty-three patients had preservation of the dorsal soft tissue envelope. All patients having a closed approach had preservation of the dorsal soft tissue envelope. Sixty-seven patients underwent DP with 38 having surface techniques and 29 having impaction techniques. Thirty-three patients underwent structural rhinoplasty with piezoelectric osteotomies and mid-vault reconstruction. All structural cases were performed using an open approach. Four revision surgeries were necessary.

Conclusions: Open and closed approaches have indications depending on the tip and dorsal deformities. A closed, PR is favored with thin skin, minimal dorsal modification, osseocartilaginous preservation (foundation techniques), less complex tip deformities, and overprojected noses. An open, PR is favored for extensive dorsal modification, S-shaped nasal bones, complex tip deformities, and tip augmentation. Structural, dorsal rhinoplasty is always done open and preferred for complex dorsal deformities and severe septal deviations.

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http://dx.doi.org/10.1093/asj/sjac074DOI Listing
April 2022

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