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Preservation Rhinoplasty: Open or Closed?

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Preservation rhinoplasty (PR) techniques, including open and closed approaches, offer distinct advantages. The choice depends on specific nasal deformities and patient factors for optimal outcomes.

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Area of Science:

  • Plastic Surgery
  • Facial Plastic Surgery
  • Rhinoplasty Techniques

Background:

  • Preservation rhinoplasty (PR) represents an evolving surgical philosophy.
  • The traditional open approach is being re-evaluated against the potential benefits of a closed approach in select cases.

Purpose of the Study:

  • To retrospectively analyze primary rhinoplasty cases to compare open versus closed approaches.
  • To identify specific indications for each approach based on patient anatomy and surgical technique.

Main Methods:

  • Retrospective review of 162 primary rhinoplasty cases (May-Nov 2020) with 100 cases having at least 1-year follow-up.
  • Data collection included dissection planes, dorsal preservation (DP) techniques (component reduction, surface, impaction), and approach (open vs. closed).
  • Structural rhinoplasty with piezoelectric osteotomies was analyzed separately.

Main Results:

  • 100 patients had ≥1 year follow-up; 56 open, 44 closed approaches.
  • 83 patients had dorsal soft tissue envelope preservation; all closed approach cases included this.
  • 67 patients underwent DP (38 surface, 29 impaction); 33 structural rhinoplasty cases (all open) were performed. Four revision surgeries were noted.

Conclusions:

  • Both open and closed PR approaches have specific indications based on tip and dorsal nasal deformities.
  • Closed PR is favored for thin skin, minimal dorsal changes, foundation techniques, less complex tip issues, and over-projected noses.
  • Open PR is preferred for extensive dorsal modification, S-shaped nasal bones, complex tip deformities, and augmentation; structural dorsal rhinoplasty is always open for complex deformities and severe septal deviations.