I am having Asian rhinoplasty. Doc told me that he will cut upper inside of mouth and insert L-shape implant. To do this way, it will not make a scar like an open procedure. I only have knowledge of Open vs Closed but I have never heard of Open inside of mouth. Is this procedure safe?
Inserting Nasal Implant Through the Inside of Mouth?
Doctor Answers (6)
Nasal implant placement by intraoral approach
A nasal implant can certainly be placed from an intraoral approach, however there is a greater risk of infection. The simplest and most conservative way to place an implant of this type is through a closed rhinoplasty procedure. We personally prefer the Flowers nasal dorsal implants and not the L-shaped struts because they make the lower portion of the nose very hard, woody and less flexible. They also become dislodged much more often and can require revision surgery.
Inserting Nasal Implant Through the Mouth
Placement of nasal implants via an intra-oral incision is an accepted technique, but theoretically there is increased risk of post-op infections. Thoroughly discuss the use of silicone implants vs your own cartilage and the advantages and disadvantages of various incisions with your surgeon. It may be helpful to get additional consultations.
I am not a fan of Nasal Implants
Implants to the nose can be placed via different incisions, including an oral incision, yet I personally do not use implants in the nose. Implants are commonly made of solid silicone, solid pieces of GoreTex, or porous polyethene (Medpore). Silicone and Goretex become encapsulated by the body. They will commonly "feel" and "move" unnaturally when touched. Medpore tends to have less encapsulation.
The primary reasons I avoid nasal implants are two-fold: (1) All nasal implants carry a small risk of future infection, which although uncommon, can be very problematic (damage or scarring of the skin, extrusion or loss of the implant requiring extensive surgical attempts at repair). (2) Implants that are placed to add shape to the nose have an increasing risk that over time they will become visible under the skin, creating a noticeable, unnatural appearance. Different tissues from your own body have been reliable tools for nasal surgery.
Bone (hard), cartilage (semi-hard), and fascia (soft) are tissues that can be used. I commonly use fascia and cartilage (typically "diced" into very small pieces to mask visibility if used under the skin) and will sometimes use bone. I have seen surgeons achieve excellent results with implants as well as with tissue grafts. As the years and decades pass after surgery, I would anticipate a higher chance of a natural appearance and a lower chance of infection or revision surgery when your own tissue has been skillfully used for an augmentation rhinoplasty. Hope this helps.
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There are different approaches to inserting nasal implants. The sub labial intraoral approach is one. My preferred technique is the open rhinoplasty approach. When performed correctly, there is virtually no scar.
There are a number of ways to approach a nose, endonasal, open and even through the mouth
Everyone seems to know about the open approach and endonasal or closed approach for Rhinoplasty. The first is through a tiny incision across the bottom of the nose. Endonasal is via totally hidden incisions, and my preference for 90% of primary rhinoplasties. Some doctors us an incision inside the mouth to insert a long L-shaped strut in Asian Rhinoplasty. This is one accepted approach. Each specialist has their preferred incisions and good reasons. Find the doctor you trust then let them perform what they feel is best for you.