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What Is the Difference Between Open and Closed Rhinoplasty? - Rhinoplasty Surgeries

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The difference between open and closed rhinoplasty does not affect the pre-operative examinations required. It is crucial to follow your doctor’s advice on this matter and to complete the requested tests. Now, since we’ve mentioned the difference between open and closed rhinoplasty, let’s also take a look at the necessary pre-operative examinations

Blood Tests

  • FBS (Fasting Blood Sugar): Checks blood sugar levels.
  • CBC.diff (Complete Blood Count): Used to diagnose anemia.
  • PT & PTT: Evaluates bleeding or clotting risks.
  • HIV and Hepatitis: Screens for the presence of these infections.

Addiional Tests

  • EKG: Identifies heart rhythm and potential heart attacks, especially for patients over 40.
  • β-HCG (Pregnancy Test): Checks for pregnancy.
  • Chest X-ray: Assesses lung condition for smokers or those with respiratory issues.
  • CT Scan: Detects sinus infections, polyps, or a deviated septum.
 

Although the techniques used in open and closed rhinoplasty differ, the preparation stages are applicable to both surgeries.

Before open and closed rhinoplasty, alcohol consumption should be stopped, and attention should be paid to this for at least 2 weeks in advance. Like alcohol, smoking is also harmful to your health, and nicotine intake should be ceased at least 4 weeks before the surgery. Smoking is allowed again 10-15 days after the surgery.

Your body needs rest before the surgery, so it’s important to ensure you get enough rest. Entering surgery with a well-rested body will help you recover and regain your health more quickly.

Another important consideration is skin cleanliness. Washing your face twice a day before the surgery will cleanse it of dead cells. Since washing your face 2-3 days after the surgery does not yield good results, it is essential to take a shower the day before the surgery

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The Difference Between Open and Closed Rhinoplasty Does Not Change The Risk of Bleeding

The risk of bleeding can occur in both open and closed rhinoplasty techniques. Since both techniques involve surgical procedures, they carry a risk of bleeding. However, managing these risks depends on the surgeon’s experience and the pre-operative preparations.

Consumption of gas-producing foods such as herbal teas, broccoli, milk, and legumes should be reduced.

The intake of blood-thinning medications like Aspirin and Ibuprofen, as well as Vitamin C, should also be stopped. Naproxen (Aleve): Increases the risk of bleeding by thinning the blood. Other NSAIDs: Medications such as Diclofenac (Voltaren) and Ketoprofen also have blood-thinning effects.

By paying attention to these points, you can ensure that both your open and closed rhinoplasty surgeries are safer and more successful

The Difference Between Open and Closed Rhinoplasty - Characteristics of Open Rhinoplasty

Open rhinoplasty is a nasal surgery technique performed with a small incision between the nostrils. In this technique, the skin is lifted to reveal the underlying structures, hence the name open rhinoplasty. Additionally, open rhinoplasty can be combined with dorsal preservation techniques. The modern open rhinoplasty approach emphasizes the preservation of cartilage and gradual modifications to the cartilage and bone structure.

Some disadvantages of the open approach are:

  • Increased risk of swelling
  • Longer surgical time
  • Destabilization of the cartilaginous structure
  • External scar

However, the majority of patients (98%) are not bothered by this external rhinoplasty scar, and 90% describe these scars as invisible or nearly imperceptible. Additionally, for patients concerned about stitch removal, the surgeon can use rapidly dissolving stitches to minimize discomfort.

Advantages of Open Rhinoplasty

  • Visibility of Internal Tissues: The biggest advantage of performing open rhinoplasty is that it allows the surgeon to access the nasal anatomy beneath the skin. This enables more precise and accurate changes to the shape of the nose. Structures can be modified rather than just removed. In many patients, cartilage asymmetries can only be seen through open rhinoplasty.

  • Better Preservation of Structural Support: The shape of the underlying cartilages can be altered with stitches, small incisions in the cartilage, and the precise placement of cartilage grafts if needed. This helps in preserving cartilage and enhancing structural support.

  • Reduced Risk of Estimation Errors: In closed rhinoplasty, the surgeon works from within the nose, which may require estimating some structural changes. Open rhinoplasty reduces the risk of these estimation errors.

  • Opportunity for Detailed Corrections: It offers the ability to make more detailed and refined adjustments to the nasal cartilage and bone structure. This is a significant advantage, especially in complex cases.

Possible Disadvantages of Closed Rhinoplasty Surgery

  • Breathing Difficulties: After closed rhinoplasty, some patients may experience difficulty breathing. This can be due to structural changes inside the nose or swelling.
  • Nosebleeds: Nosebleeds may occur after closed rhinoplasty. This usually happens within the first few days after surgery and often resolves on its own.
  • Numbness in the Nose: After closed rhinoplasty, there may be a feeling of numbness in the nose and surrounding area. This could be due to nerve damage and may be permanent in some patients.
  • Asymmetric Nose: Asymmetry in the nose may occur after closed rhinoplasty. This can be a result of the nature of the surgical intervention and may not be aesthetically satisfying.
  • Scars: Although there are no noticeable external scars in closed rhinoplasty, internal incisions can leave scars as they heal, which may be bothersome.
  • Allergic Reaction to Anesthesia: Some patients may develop an allergic reaction to the anesthetic agents used during closed rhinoplasty. This can lead to serious complications and may require emergency intervention.
  • Prolonged Bruising: Prolonged bruising around the face and nose may occur after closed rhinoplasty. This can negatively impact the patient’s social and professional life.
 

The Difference Between Open and Closed Rhinoplasty

The difference between open and closed rhinoplasty stems from the technical aspects of the surgeries. The decision on which type of surgery to choose is based on the patient’s needs. If there are nasal deviations, open surgery is preferred. In cases where the nose is straight and there are no breathing issues, closed surgery, which also has a quicker recovery time, is recommended.

The ligaments, where the nasal skin adheres, are kept intact. This provides more comfort in the tip of the nose and allows for faster healing. Open rhinoplasty is preferred when the nose has suffered significant damage and requires better visibility. Additionally, if a patient has previously undergone an unsuccessful open rhinoplasty, an open procedure may again be chosen. It is more appropriate to decide which surgery to undergo by consulting a trusted physician.

Open rhinoplasty is preferred for crooked noses, asymmetrical noses, nasal tip pathologies, and nasal cartilage pathologies. For humped and wide noses or noses with cartilage tension, closed surgery is more commonly chosen.

In closed rhinoplasty, there is typically less bruising, and the recovery process is faster. The scar from open rhinoplasty is external, while in closed rhinoplasty, it remains internal. Open surgery is more often chosen to achieve a wider view of the nose. In closed rhinoplasty, revision rates can reach up to 20%, while in open rhinoplasty, the rate is around 5%.

Closed surgery is preferred to avoid numbness in the skin. Surgeries performed with the closed method can be more intricate. Closed rhinoplasty is crucial for maintaining nasal tip sensitivity. In closed surgeries, the ligaments between the skin and cartilage that create nasal tip flexibility are not cut. This allows the nasal tip elasticity to continue post-surgery.

In closed rhinoplasty, there is typically less bruising, and the recovery is quicker. The scar in open rhinoplasty is external, while in closed rhinoplasty, it remains internal. Open rhinoplasty is preferred when the nose has suffered significant damage and when a wider appearance is required. Additionally, open rhinoplasty may be chosen for patients who have previously undergone an unsuccessful open nasal surgery. This article discusses the differences and details of open and closed rhinoplasty. Consulting a trusted physician is the best way to decide which surgery to undergo.

Rhinoplasty Surgery and Breathing Difficulties

Breathing difficulties may occur after rhinoplasty surgery. The reasons for this are as follows:

  • Cauterization of Nasal Turbinates: During surgery, when the nasal turbinates are cauterized, scabbing can occur. Once these scabs are cleaned and the nose is irrigated, breathing typically becomes easier. However, if breathing difficulties persist after a month, once the scabbing has ended, there may be several reasons for this:

    • Inadequately Reduced Nasal Turbinates: The nasal turbinates may not have been sufficiently reduced.
    • Cartilage Displacement: The shifting of internal cartilages can block the nasal passage.
    • Nasal Dryness: If everything seems fine but breathing difficulties persist, dryness in the nose may be the issue.
  • Complete Healing Process: It takes a minimum of 6 months for the nose to fully heal, during which about 60% of the healing occurs. During this period, breathing difficulties can arise from adhesions or internal and external nasal valve collapse. Collapse of the nasal wings can also cause breathing difficulties, so these cases should be carefully examined.

Septoplasty and Septorhinoplasty Surgeries

Septoplasty is a surgery to correct the nasal septum and is performed to restructure the nose. In septorhinoplasty surgery, the septum is corrected and the nasal structure is balanced. Septal deviations can cause enlargement of the nasal turbinates. In the same session, the turbinates are also cauterized and reduced to relieve breathing difficulties. The surgery usually takes 15-20 minutes and is performed using a closed method. After the surgery, silicone splints are placed in the nose. The patient can usually be discharged on the same day.

 

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