Closed Rhinoplasty: A Single Surgeon Experience of 238 Cases over 2 Years

Closed rhinoplasty is currently losing favour as a method of rhinoplasty reshaping procedure. Open rhinoplasties are usually performed by surgeons because of the greater degree of visualisation of the cartilages and bones within the nose that need to be reshaped. Because of the criticisms of closed rhinoplasty the senior author performed an audit of his outcomes to determine whether closed rhinoplasty still has a role to play in the armamentarium of the plastic surgeon. We conducted this study as a retrospective review of all closed rhinoplasty operations performed by a single surgeon over a two-year period (from 1st January 2016 to 31st December 2017). The operative technique is provided. An independent panel of 3 assessors (2 board certified consultant plastic surgeons and one lay member of the public) rated outcomes of the closed technique based on photographic series. Statistical analysis was performed using Cohen's Kappa and Friedman test. Additionally, the length of follow up period, revision rates, and post-operative complications (general and aesthetic) were examined. A total of 242 cases of rhinoplasty were performed (8 open and 234 closed rhinoplasty; 225 primary and 17 revision operations). The first consultant surgeon gave a score in a range from 4.2/5 to 4.9/5 with a mode of 4.8 and a mean score of 4.7/5. The second consultant surgeon gave a range of 4.1/5 to 4.9/5 with a mode of 4.4 and mean score of 4.3/5. The lay panel member scored the cases in a range from 4.4/5 to 5/5 with a mode of 4.8 and a mean score of 4.9/5. Cohen's coefficient was 0.72 showing substantial agreement across the panel. The complication rate for the recorded data was 0.8% with two cases of soft tissue infection treated with oral antibiotics. The results of this paper advocates the benefits of the closed approach in aesthetic rhinoplasty. Surgeons should appreciate that both open and closed approaches are complimentary. The favouring of a single approach is indicated in the scenarios discussed. The remaining cases seem to produce equivocal results and the choice of procedure should be based on patient anatomy, outcome aims, and the ability of a surgeon to perform their preferred technique.