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Open
vs. Closed: There are two approaches to working
on the inside of the nose, referred to as "open"
and "closed". In the external or "open"
rhinoplasty, most of the incisions are inside the nose
with the exception of an incision across the columella
(the skin between the nostrils). With endonasal or "closed"
rhinoplasty, all the incisions are hidden inside the
nose, so there are no external or visible scars.
There is no "right way"
when it comes to deciding between an open or closed
approach. It really depends on which way the surgeon
feels will give you the best result, which technique
your surgeon prefers, and what you are comfortable with.
The open technique may be preferred because the incision
between the nostrils allows the surgeon to better visualize
the anatomy and structures of the nose as he or she
is operating. On the other hand, the closed technique
keeps visible scarring and formation of scar tissue
to a minimum. You should discuss these options with
your plastic surgeon before the operation.
Grafts & Implants: Often
times, primary rhinoplasty (the first time your nose
is operated on) involves removal of tissue to create
the desired effect. In secondary, or revision, nose
surgery, the procedure frequently requires replacing
or adding tissue or grafts to compensate for the unwanted
results of the prior surgery.
Grafts are used to rebuild the nose
and fill in the areas that lack enough tissue in the
bridge of the nose (known as the dorsum) as well as
in the base. They can be made from the body's own tissue,
such as cartilage or from a synthetic material.
Cartilage Grafts: Cartilage
grafts can be taken from the septum deep within the
nose, from the ear, or from a rib. It is easiest for
the patient if it is taken from the nose; however, if
not enough tissue is present, the ear cartilage is a
good alternative. Cartilage grafts tend to look and
feel more natural than synthetic grafts, but in rare
instances, they can deteriorate or be absorbed by the
body.
Synthetic Implants: Types
of synthetic implants include silicone (Implantech and
Inamed Aesthetics are two popular manufacturers), expanded
polytetrafluoroethylene (ePTFE) implants (SoftForm®
and Gore-Tex® are the two most popular) and Polyethylene
Implants (MEDPOR®) and Hydroxyapatite Implants.
There are many different types and materials to choose
from which offers some flexibility and options for the
surgeon, but synthetic implants are sometimes more easily
felt and seen than cartilage grafts if they are not
placed correctly. Some surgeons also have found that
synthetic implants may be more prone to infection than
cartilage grafts.
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