Are Incisions Under the Eyes Necessary During Some Rhinoplasty Procedures?

There are many ways to correct nasal contour.  The small incisions beneath your eyes I would guess would help the surgeon narrow the nose.  Most surgeons use the internal incision present during rhinoplasty to narrow the nose.  Some surgeons feel more comfortable with one technique versus the other.  The small external incisions are just that VERY SMALL (2 mm) and heal extremely well.  Both techniques are very acceptable.

Dr. ES

It is not necessary to make incisions under the eyelids for a rhinoplasty.   There are many other better methods to perform rhinoplasty,  and if the incisions do not heal prefectly they are hard to correct.  Best regards,   Dr. Smith

It is not very common to perform rhinoplasties by making incisions under the eyes. Most likely these are small incisions that are being recommended but generally speaking are not necessary as most narrowing procedures are done through incisions inside the nose or along the columella or bottom of the nose. You might want to get a second or third opinion. I hope this information helps.

Hello Boston9626-

Insightful question....the "incisions" you speak of are the access points for the surgical instrument used to make small perforations in the nasal bones (much like the holes on a stamp) allowing them to break. Breaking the nasal bones allows the surgeon to nasal the middle width of the nose. This can also be done through incisions or access points on the inside of the nose.

I have used both approaches...individualized for each patient. External skin incisions, below the eyes as you state, may have a mechanical advantage and may lessen the risk of bruising and swelling. Whereas, the internal approach, although there is not a scar on the outside, uses a cutting technique that cuts bone and blood vessels, leading to more swelling and bruising (raccoon eyes).

Patients are individuals and have different anatomic requirements....benefits of both techniques. I know Boston well...please say hello to my professors...they taught me well. But, I would recommend that you continue to educate yourself and see as many surgeons as you can to find your comfort zone. A Board Certified Plastic Surgeon who loves rhinoplasty and is dedicated to the procedure, critically annalizes his/her outcomes, shows you their work and makes you feel confident in their ability to achieve YOUR goals...like a beautiful nose without any external scars below the eyes! 

Hope this helps!

Dr. C

johnconnorsmd.com

In 35 years of doing thousands of rhinoplasties, I have never had to make an incision under the eyes. You can fracture the bones from the inside without any problem. See another experienced rhinoplasty surgeon for another opinion.

You may have misunderstood what your surgeon told you. The most common external incision used during rhinoplasty surgery is on your columella at the base of your nose. Incisions under your eyes are not performed.

I hope this is helpful for you.

For Primary rhinoplasty, I prefer the intra-nasal (or closed) approach. for over 90% of my rhinoplasties. This means no incisions at all on the outside of the nose. Some very respected surgeons use an external incision on the bottom of the nose for an open approach and others even use a tiny "stab" incision under the eye in a natural crease perform osteotomies (breaking of the nasal bones). Personally, I make these osteotomy cuts inside the nose as well.

Incisions underneath the eyes for a rhinoplasty are totally unnecessary. Osteotomies are all performed through tiny incisions inside the nose underneath the sidewall of the bone. Look for a surgeon who can perform a primary rhinoplasty with the closed technique, not open rhinoplasty. A simple reduction rhinoplasty can easily be performed by closed rhinoplasty. This means that all the incisions are placed internally. Busy rhinoplasty surgeons today usually perform between two hundred and three hundred rhinoplasties per year. Look for a surgeon who is board certified in facial plastic surgery and whose original background is ear, nose, and throat surgery or otolaryngology.  

Every surgeon has their preferences when come to break the bone to narrow the nose. There are more older surgeons use the external osteotomy. If you scar well and your surgeon is very good in all other aspects by all means go with them. Otherwise consult another surgeon. I personally had never needed to make an external incision for a close or open rhinoplasty.

Hello, Boston friend.

Was there recently for the major head and neck surgery convention. Loved the town. Fabulous history. Cute narrow streets. Great food.

Now, getting back to business. Some surgeons do prefer to use tiny chisels, placed through short incisions placed between the side of the nose and the eye area to help crack the nasal bones to narrow them. This is done after the bump is removed. These fine instruments are only 2mm or 3mm wide. Therefore the incisions are very tiny and heal well.

In certain cases where the nasal bones were very thick and refused to narrow using the internal chisel approach, I have done what I believe the professor is recommending. It does work. Healing is excellent particularly when the tiny wounds are closed with one or two very fine stitches. The dissolving kind works beautifully.

Don't sweat that particular technique. The most important issue is: How do the doctors' noses look? Do you like the results you see on his website? In his office " before and after" album? That is really what counts: the results. If you see dozens and dozens of natural-looking noses, you should be comfortable with the doctor. If you are uncertain, then have the doctor do computer imaging to show you the nose he would deliver to you. That is always very important; a meeting of the minds, without guessing about outcome.

Do your homework. Don't mean to brag but my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON will help make your research/homework easier. Wrote it for Bostonians and everyone else. Every bookstore has it.

Best wishes to the Patriots!

-Robert Kotler, MD, FACS

 Beverly Hills, CA