How do you know not to hit a vessel during closed rhinoplasty (afraid of blindness)?

Question

I'm having a revision rhinoplasty soon, this time it's going to be a closed surgery through the nostril. He is going to shave away a lump on the bone and remove a little bit of cartilage. I'm worried about becoming blind. How can you tell where blood vessels/arteries are during a closed surgery? And also, how to know how much you can shave off the bone? I'm also afraid to get a hole through the nasal bone if he shaves to much? A different surgeon told me that can happen.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. The choice of approach, open or endonasal (closed) depends on the anatomy of your nose and, to a large extent, the surgeon's personal preference.  Yes, you nose can be narrowed through an endonasal approach; just make sure you choose a surgeon who does a lot of endonasal rhinoplasty.

Suleyman Tas, MD, FEBOPRAS · Answer

Hello,Thank you for your question. All surgeries including revision cases I perform with the Closed Rhinoplasty which is much more difficult, doesnt leave visible scar, and prevents tissue damage. In experienced hands there is no risk of becoming blind. Ask all questions concerning you prior to your surgery to your doctor as this communication is extremely important. Revision rhinoplasty requires extended experience, skills and knowledge. To find out more revision before and after pictures please click on the attached link. Best Regards

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Blindness would be extremely unusual after rhinoplasty. I have never seen it after rhinoplasty. I prefer to do all revisions using open technique. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Ronald J. Edelson, MD · Answer

Blindness is exceeding rare from rhinoplasty. The artery that supplies the optic nerve is nowhere near where the nasal work is done.

Robert Deeb, MD · Answer

Hello and thanks for the question.  As someone who also performed the closed approach, the likelihood of blindness is exceedingly rare and the closed approach does not make it more likely to occur compared to the open approach. In terms of knowing how much to "shave", this is dependent on the skill and expertise of the surgeon; again the approach does not necessarily increase the risk of "shaving too much" or "creating a hole". Hope that helps and good luck

Robert L. Kraft, MD, FACS · Answer

I have never seen this complication in 35 years of practice.   The blood vessels should be nowhere in the vicinity. Have surgery only with a board certified ENT or plastic surgeon.

William Portuese, MD · Answer

We have been performing closed rhinoplasty for over 30 years and  have never heard of or seen blindness occurring.  You can get blindness from fillers injected in the face, not a rhinoplasty

Csaba L. Magassy, MD (in memoriam) · Answer

The procedure of closed rhinoplasty is usually performed by experienced Plastic Surgeons. The approach is such that avoids the major blood vessels of the facial area, they are rather consistent in their position. When not, there are telltale signs of some type of abnormality. An experienced Plastic Surgeon can recognize and abnormality with a thorough examination.

How do you know not to hit a vessel during closed rhinoplasty (afraid of blindness)?

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