You Will Need an Open Rhinoplasty
Having already had 3 rhinoplasties, you have a fair
amount of scar tissue, and the only way to truly visualize the remaining
cartilage and correct the structural problems is to do an open
rhinoplasty. Closed rhinoplasty
approaches for revisions can sometimes address a specific problem, such as a
localized bump, but a closed procedure cannot possibly make significant changes
in a predictable way. The relatively delicate cartilages are encased in a layer
of scar tissue, which makes careful dissection and meticulous uncovering of the
remaining cartilage essential. If the surgery is done carefully, the skin
should not be at risk. Again, a
meticulous dissection is necessary, staying at a level just over the cartilage to
avoid thinning the skin.
Closed vs Open Rhinoplasty
I'm sorry you've had so much surgery trying to achieve the desired results. I understand your frustration but at this time I suggest you concentrate on selecting the best surgeon without trying to determine the best technique.
Open: much much better.
Especially for a fourth operation, I highly recommend the open approach. The skin doesn't do worse with open than it does with closed, so that's not an issue.
Why do you need a fourth operation? See the "Web reference" link, just below my response. It gives valuable information on making sure that your surgeon has given you a good evaluation and has the skill to work on your nose. You might want to peruse the rules there and make sure your surgeon fits the bill.
In my opinion, an open rhinoplasty often gives better visualization. Remember though, the skin elevated may be at more risk with each revision.
An open or external rhinoplasty approach may allow your surgeon to have increased visibility and control with a nasal revision.
We use an open approach on nearly everyone requesting rhinoplasty surgery. A reddish nose could be related to rosacea, or your prior surgeries. The goal should be to get to a place where you are satisfied with your nasal appearance, so interview several rhinoplasty specialists so you could see what might be best for you moving forward.
Closed versus open approach for revision rhinoplasty
The closed versus open approach is only about placement of the incision across the columella. A revision rhinoplasty can be accomplished with either closed or open approach, depending upon the surgeon's preference. Look for a very experienced rhinoplasty surgeon for best results, not about which technique they use
Closed versus open
The risk of vascular injury or skin necrosis is higher with open approach in revision rhinoplasty. However the excellent view it provides definitely helps in better control of all the grafts that her implant. This is a very tough question to answer. A person with reddish skin is no different than regular skin. The most important thing is the comfort level of you surgeon with this approach. If you surgeon feels comfortable that you will not have any issues then you should go ahead.
Hello and thank you for your question. For complex repeat revisional rhinoplasty, I generally prefer the open approach. This will not have any adverse affects on the skin compared to the closed approach. The most important aspect is
to find a surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Open vs closed approach for revision rhinoplasty
For revision rhinoplasty primarily involving modification of the tip, it is generally best to perform through an external approach. This provides the best view for accurate analysis and surgical management of problems related to asymmetry, altering tip refinement, placement of grafts or other techniques to achieve the goals of surgery. Closed rhinoplasty however would be appropriate if the revision is minor such as rasping of the bony dorsum or osteotomies without tip work.
Open and closed rhinoplasty have little difference in the way the skin heals, even with revision rhinoplasty
In revision rhinoplasty, there are often so many unknown things to deal with such as warped cartilage, unknown grafts, unusual twisting of bone and cartilage that an open approach gives more information to your surgeon. We also may get a more precise placement of grafts that we often use in revision rhinoplasty. The skin is not more at risk from either approach. Other than more information, the tiny incision across the bottom is the only real difference.