Open Closed Approaches
Open versus Closed Rhinoplasty Approaches: There is much debate on these two approaches. Below is a picture of a nose from underneath or a worm's eye view. The wavy green line shows a reverse gull wing pattern for the transcolumellar incision. The area of the nose shown between the nostrils is called the columella:
You can find more about the Rhinoplasty procedure by clicking and reading this link: Learning the Procedure. There you will be taken through some of the steps a Rhinoplasty Surgeon goes through during a Rhinoplasty.
More on the Open versus Closed Approach: So what are the positives and the negatives? The Positives for the Open Appraoch is that the anatomy is more clearly seen in its natural form. The anatomy is much more easily manipulated and observed after each manipulation. Exposure is wider and offers the Rhinoplasty Surgeon a better view. The Negatives for the Open Approach include the obvious scar on the outside. It also seems to affect the blood supply to the tip giving it more chance for part of the skin to become devascularized and likely to have issues healing. The columella is more at risk given the incision through it. Also you have to replace the skin over the tip to see what your maneuvers are actually accomplishing with the open technique. The Positives for the Closed Rhinoplasty Technique include faster healing. You can manipulate the structures and have an easier time observing what these changes are doing to the nose. You will have less swelling after a closed approach rhinoplasty. You also avoid the external scar in the Closed Rhinoplasty. The Negatives for the Closed Rhinoplasty Approach are found in the open approaches positives. With the closed approach, your visibility is impaired. You have to do more maneuvering around the skin and connections to create changes and you aren't able to see the structures easily in its natural form. Some structures are harder to get to through a closed approach. This may make changing the nose much more difficult and hence the results are sacrificed at the expense of faster healing and the avoidance of the small transcolumellar scar.