Where are the incisions made for rhinoplasty?
There are two ways to access the internal structures of the nose for making aesthetic and functional improvements. Surgery performed entirely through the nostrils is called the endonasal method and is the traditional approach. The open method includes an incision across the skin between the nostrils and is a more recent development (Figure 4, left).
The endonasal method remains ideal for those requiring only simple changes such as hump removal and minor tip modification. It also works well for those only requiring internal work to correct a breathing disorder. The advantages of this method are that there is less swelling postoperatively and it is more efficient to do. The disadvantage is that the visibility of structures inside of the nose is more restricted for the surgeon.
The external incision used with the open method allows lifting of the tip skin to expose the entire internal framework of the nose to direct vision. This greatly aids examination of the underlying structures that determine nasal shape. Changes can be made more precisely and more technical options can be used with this method. This technique is particularly helpful for executing delicate tip shaping maneuvers, adding cartilage grafts, and for reconstructing a tip deformed by previous surgery. Tip swelling takes longer to resolve compared to the endonasal method and the procedure takes longer too. However, the benefits afforded by the improved visibility are worth it and the scar is typically insignificant (Figure 4, right).