Preservation Rhinoplasty: Open or Closed?
Aaron M. Kosins
Abstract
BACKGROUND: Preservation rhinoplasty (PR) is an evolving philosophy. OBJECTIVES: The open approach was initially utilized, but the author felt a closed approach might be of benefit in certain patients. METHODS: A total 162 primary rhinoplasty cases were studied retrospectively between May and November 2020. One hundred cases had at least 1 year of follow-up. Patients had follow-up at 1 week, 1 month, 3 months, and 1 year after surgery. Technical details were recorded, including dissection planes, preservation of the dorsum (DP) vs component reductions, surface vs foundational DP techniques, and open vs closed approach. RESULTS: One hundred patients had at least 1 year of follow-up. Fifty-six patients underwent an open approach and 44 a closed approach. Eighty-three patients had preservation of the dorsal soft tissue envelope. All patients who underwent a closed approach had preservation of the dorsal soft tissue envelope. Sixty-seven patients underwent DP, with 38 receiving surface techniques and 29 undergoing impaction techniques. Thirty-three patients underwent structural rhinoplasty with piezoelectric osteotomies and mid-vault reconstruction. All structural cases were performed employing an open approach. Four revision surgeries were necessary. CONCLUSIONS: Open and closed approaches have indications depending on the tip and dorsal deformities. A closed PR is favored with thin skin, minimal dorsal modification, osseocartilaginous preservation (foundation techniques), less complex tip deformities, and overprojected noses. An open PR is favored for extensive dorsal modification, S-shaped nasal bones, complex tip deformities, and tip augmentation. Structural dorsal rhinoplasty is always conducted open and preferred for complex dorsal deformities and severe septal deviations.