Closed rhinoplasty or scarless rhinoplasty is an excellent procedure in the properly selected patient. Scarless rhinoplasty involves making incisions only within the nostrils, so that the scars are hidden and difficult to see from the outside. This does make the surgery faster, and swelling typically will be less than a comparable open rhinoplasty procedure. Scarless rhinoplasty and closed rhinoplasty work best in patients with:
- near ideal tip support
- near ideal tip aesthetics
- adequate dorsal height and projection
- thin to moderate thickness skin
Closed rhinoplasty and scarless rhinoplasty faces serious limitations in patients with:
- weak nasal tip support
- wide, bulbous or ptotic nasal tip
- lack of projection
- lack of dorsal height
- very thin, or thick, sebaceous skin
The best candidates for closed rhinoplasty and scarless rhinoplasty are those patients with near ideal tip aesthetics and seeking only a very mild change to the appearance of their nasal tip, but do want to address contours along the nasal dorsum such as a dorsal hump or wide lateral nasal sidewalls. Anything beyond a minor change to the tip of the nose often will be better served through an open rhinoplasty approach.
This beautiful patients underwent a previous scarless rhinoplasty with another surgeon with overall good results, but with some contour irregularities along the nasal tip and a lack of definition along the tip-alar transition. Using unified tip grafts crafted from her septal cartilage and cartilage from her ear I was able to create a smoother nasal tip contour and redefine the tip, ala and nostrils.
With proper incision design and execution, an open rhinoplasty will also leave a “scarless” appearance, with greater refinement and definition of the nasal tip complex.
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