Rhinoplasty: Q&A
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Closed Rhinoplasty to Repair Nasal Wall?
I have nasal wall collapse after an open Rhinoplasty a few years ago. Now, with every breath the side walls of my nose perceptably luff, like a bellows and my nostrils flare slightly. Clearly, my nose does not have enough structure.
My question is: Can this now be rectified with a closed procedure, given that the primary was open? Please advise, and thank you.
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16 Doctor Answers |
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SaraFina
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Functional rhinoplasty to repair valve collapse
You are correct that 'closed' (or as we call it, endonasal) rhinoplasty can repair lateral wall insufficiency (collapse). However, it is often best accomplished with an external ('open') approach. Since you have already had this done (the first rhinoplasty was 'open'), it would probably increase your chances of success to have it done externally. This would give your surgeon the best chance to assess the issues and accomplish structural repair. Of course, without examining you this is only...
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Open rhinoplasty for internal valve collapse
To directly answer your question, a secondary closed approach can be used after an initial open approach. However, my suggestion to you is to revisit open rhinoplasty.
First, it sounds to me like your collapse is the internal valve, not the external valve. If it is the nasal sidewalls, roughly the middle third of the nose that bellows, that is the internal valve. If it is the nostrils that collapse, then think external. The fact that you mentioned nostril flare to me suggests internal...
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Mid-Vault Nasal Reconstruction After Primary Rhinoplasty
Yes, the endonasal approach can be used to reconstruct a collapsed nasal mid-vault. In most cases, this would involve harvest of nasal septal cartilage for spreader grafts and placement of these spreader graft to support the internal valve. If there is also posterior dislocation of the upper or lower lateral cartilages, then these cartilages would have to be repaired or supported.
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Closed rhinoplasty to repair valve collapse
It sounds as if a valve collapse has occurred due to the open rhinoplasty.
Structural grafting with cartilage from the inside of the nose and placing spreader grafts to the upper lateral cartilages will dramatically help with this. Alar batten grafts and supra-alar rim grafts can also help with the nostril rims if they are collapsing as well. These can be accomplished through closed rhinoplasty.
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Nasal Valve Collapse and Surgical Approach
The only thing harder than revising an open rhinoplasty with a closed technique is doing it open again.
If you only require cartilage grafts (onlay or spreader grafts) to strengthen the midportion/sidewalls of the nose, then there is no need to perform an open rhinoplasty and dissect through the tip again. If extensive grafting is required for the tip cartilages as well (batten grafts), then an open may be indicated. In my experience, there is more scarring of the nose after a previous open...
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Revision of Rhinoplasty
You are correct that you lack support for the nose on inspiration. This will likely call for grafting, or changing the internal anatomy of the nose. The biggest concen is if there is enough cartlilage to reinforce the structures.
A closed approach may be possible if you get a surgeon experienced and confident that he can fix the problem, after an exam.
The thing is that you already had an open procedure so why not go that way again, as it gives best exposure and ability to correct the...
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Nasal wall collapse can be treated with Closed Rhinoplasty
Nasal wall collapse is usually caused by internal nasal valve weakening in the area where the upper lateral cartilage attaches to the nasal septum and nasal bones. This area can be approached with closed rhinoplasty and rebuilt with cartilage grafts usually taken from the nasal septum. Some doctors are more comfortable with an open approach but a surgeon skilled at closed rhinoplasty can treat this even after a prior open rhinoplasty.
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Nasal wall collapse
While a closed rhinoplasty can certainly correct nasal valave collapse, I prefer to perform the procedure open to perform a controlled correction of the problem.
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Correction of nasal wall collapse.
This can be done by either the open or closed approach. If the remainder of the nose is fine the closed approach is preferable. You should see an experienced revision rhinoplasty surgeon. Correction of problems like this is best done with your own tissue, not an implant.
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Collapsed nasal walls can be treated by either open or closed rhinoplasty
The specific approach for strengthening a collapsed nasal wall is not as important as the technique used to support that wall. There are generally two areas of collapse possible, called the internal and external nasal valves. Depending on your specific examination, grafts can be uses to strengthen either one or both of these areas. I suggest you seek out a revision specialist for more specific answers.
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Nasal Valve Collapse
Hi,
What your describing is called Nasal Valve Collapse. NVC is a weakness or lack of supporting cartilage in your nose that is responsible for keeping your nose open during inspiration.
Whether a surgeon chooses an open or closed approach will depend on his/her experience with that particular technique. I prefer the open approach because it allows me to see the nasal valve collapse directly and repair the collapse using cartilage grafts from the ear or the septum.
Best,
Dr.S....
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Correcting nasal collapse
Depending upon your area of collapse, the approach could be open or closed. If it is just collapse of the ala above the nostril rims, then yes cartilage grafts as lateral crural strut grafts can be placed in precise pockets to help that area. However, you may also be describing collapse of the side walls of your nose. If that is the case you might need either spreader grafts or the bones to be outfractured. You need an examination by an experienced rhinoplasty surgeon to help make that...
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Nasal sidewall collapse and secondary rhinoplasty
As stated by Dr. Persky, the nasal sidewalls can be supported with lateral crural strut grafts to minimize inspiratory collapse and expiratory distension. The preferable source for the grafts is the septum. However, if this was used at the initial procedure ear cartilage or alloplastic materials may be required.
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Rhinoplasty for nasal valve collapse
In general revision rhinoplasty is easier through an open approach, but if your only concern is this area, it can be done through a closed approach. Be sure to see a board-certified surgeon in your area who has experience with revision rhinoplasty. Good luck and best wishes, /nsn.
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Collapse of External Nasal Valves; Repair with Open or Closed Approach?
Hi,
Collapse of the external nasal valves can be repaired through either a closed or open approach. If your revision surgery is to correct the collapse only, I would prefer to approach it through a closed approach with small precise pockets created for the cartilage grafts or medpor porex implants.
Good luck and be well.
Dr. P
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Nasal surgery for you depends on exam
Hi, If you have nasal valve or wall collapse with inspiration than cartilage grafts through a precise-pocket CLOSED approach can be used to rectify the problem. But you need a thorough examination to make sure this indeed is the problem before offering a closed or an open solution. But in general, closed minor revisions can be made after open procedures.
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