The Art of Rhinoplasty & Revision Nose Surgery Using the Closed Technique

Open Vs. Closed

The art of revision rhinoplasty surgery has been developed over 35 years fixing or altering previously operated on structures of the nose practicing and perfecting the “closed” surgical technique.  The “open” surgical technique for nasal surgeries limited the surgeon in many significant ways.  Open technique does not allow certain degrees of finesse in placing cartilage grafts in exacting locations in order to correct deformities that are commonly found in revision rhinoplasties.  In my experience with the closed technique, making small incisions and taking cartilage from the nasal septum or the ear, I can accurately place small millimeter-sized grafts into various locations throughout the nasal tip, the dorsum, and sides of the nose sparing the patient extensive and invasive surgical intervention.   Open nose surgery requires a much greater disturbance of the nasal structures.  A surgeon cuts the skin under the tip of the nose and literally removes the soft tissue back from the cartilage and bridge giving the doctor a completely open visual field and access to deep parts of the nose.  This technique is used to teach plastic surgeons how to manipulate the nose and remove unwanted sections to shape and reduce areas in size, so it is a far easier method.  The problem is, it completely exposes the most vulnerable part of a patient’s face and is far more abrasive in terms of the invasiveness of the procedure.  This technique also distorts the normal anatomical attachments of the skin to the nasal bones and nasal cartilages, further complicating the surgeon’s ability to perform a natural revision rhinoplasty.  Infection risk and scar tissue formation both increase dramatically with the open technique.  One of the most important factors to consider is the result in shape and size is often much harder to determine with this method, often resulting in undesired results.

Closed: How It Works

The patient is seen in the treatment room preoperatively and in the upright position.  The surgeon has direct communication with the patient prior to surgery, and exact locations for cartilage grafts are discussed and agreed upon by both the patient and the surgeon.  Once the various ink marks are made on the outside of the nose, the patient is then taken to the operating room and given intravenous sedation—a voiding all narcotics and anesthesia gases.  This type of anesthesia virtually eliminates nausea and drowsiness which are the most common negative side effects of anesthesia.  After harvesting cartilage from the nasal septum or the ear (and occasionally the rib), small incisions are made inside the nose in order to accomplish the reconstructive portion of this rhinoplasty procedure.  The anesthetic used is local in the entire area of the nose in addition to intravenous sedation.  Intubation and deep general anesthesia is avoided to ensure much less nose bleeding encountered during the procedure, allowing for even further improvement in technique because of the limited amount of blood loss.  The small cartilage grafts are placed where the surgeon marks the external aspect of the nose with ink in order to map out the correct placement of the grafts.  There is very little discomfort to the patient postoperatively because packing is never used and because of the less invasive nature of the closed technique.  Also during recovery pain and swelling are absolutely minimal because the open technique has been avoided preventing unnecessary incisions and unnecessary dissection throughout the nose area.  The exact appearance of the nose can be noted right after the surgery, and considering the minimal swelling the long two to three-month delay in seeing the final result is avoided when the open technique is used.

The closed nose surgery technique is used by the most skilled plastic surgeons with results far surpassing those of the open nose surgery technique.  The procedure results in extremely high patient satisfaction with minimal discomfort and quick recovery time.  Choose this method for rhinoplasty and revision nose surgeries every time!

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Combining Juvederm and Rhinoplasty for Best Results

The combination of surgical Rhinoplasty, either primary or secondary, combined with injecting Juvederm into the nose has gotten superior results and excellent patient satisfaction.  Juvederm is a hyaluronic acid which can last up to a year and sometimes longer when injected into various facial irregularities, defects, or deep facial lines (such as laugh lines, crease lines, or chin lines).  Juvederm has also been known to be used to inject around the mouth area  (vertical lip lines) or into the lips themselves.  This smooth cosmetic filler is also highly successful when injected into a variety of nasal defects.

Juvederm can be used in both primary and secondary rhinoplasties to help improve the aesthetic result of cosmetic nose surgery without actually doing further invasive surgical procedures to the nose.  Some irregularities throughout the nose and tip area, especially those in patients who have had several rhinoplasty operations, can often be readily improved in an office setting without surgical intervention using approximately 1 cc of Juvederm or less with a small gauge needle that causes extremely minimal patient discomfort.

The nose, nasal dorsum, or tip can be revised substantially and improved tremendously, by injecting these cosmetic fillers.  A recommended combined approach for rhinoplasty or revision rhinoplasty using Juvederm is to use this filler as an ancillary procedure during the rhinoplasty rather than operate on a certain part of the nose, which can be difficult and not as predictable. The cosmetic filler is then injected into the nasal tip, the dorsum, or the sides of the nose resulting in an improved surgical result with virtually no downtime to the patient and an extremely fast recovery.

Basically, the nose is the most difficult part of the face to operate on and certainly to perfect.  Surgical intervention is often necessary but simply cannot create the exact look a patient is looking for without a little help from fillers.  I take something away when I make a nose smaller and contour the details of that nose to fit the face of each patient.  Every single nasal structure is different on every single face, so often in that process of removing the unwanted features Juvederm is the amazing tool to take advantage of to add structure and fullness to areas of that nose to ultimately sculpt a natural-looking, gorgeous nose.  Patients often have several rhinoplasties, determined to fix features on their noses that they aren’t satisfied with, and this practice often ruins nasal structures completely and causes undesirable indentations and even collapse.  If done properly by a highly trained and skilled plastic surgeon, a first time rhinoplasty will give a patient the look they have always wanted.  Cosmetic filler used to achieve that end result is such a more favorable route to take than operating multiple times on the same nose.  Juvederm lasts up to a year and often longer, and can give you the perfect nose for your face.  It is definitely worth the fast, affordable, and almost painless “up keep” that this process requires.

In one of my extremely thorough consultations, you could even discover that no surgical intervention is necessary.  I can perform a “liquid nose job” using Juvederm to change the shape of the nose entirely.  Few people are aware that this practice exists, and even fewer surgeons will suggest this option and skip the surgery.  For the right candidate, filler instead of a rhinoplasty can save that patient a tremendous amount of money and eliminate recovery time that the surgery requires.  At the Clavin Center, you are in highly trained and skilled hands.  I, Dr. Clavin, perform all the cosmetic procedures and surgeries, and my favorite of all of these is rhinoplasties.  I have developed some of the best techniques and certainly can give patients optimal, natural-looking results that will improve the look of the entire face.  And, I will always recommend what is best for the patient and his or her individual circumstance.

http://www.clavin.com
1-310-829-5977