The Spire Hospital Bristol, The Glen, Durdham Down, Bristol BS6 6UT Tel: 0117 968 8144

Rhinoplasty - Open Tip or Closed Tip

Rhinoplasty is one of my favourite procedures. It can be a fine and elegant operation even during revisions. I see patients from all over the country many of whom are seeking a second opinion or revision to a rhinoplasty performed elsewhere and sometimes decades ago.

Rhinoplasty Surgery and Rhinoplasty Revision

Rhinoplasty is a highly skilled procedure requiring a highly competent, specialist rhinoplasty surgeon who uses modern techniques. It is probably the cosmetic procedure that has the highest complication rate.
 
Acute complication such as bleeding or infection are incredibly rare but the need for revision surgery is increasing as surgeons who are not experts offer cheap nose-jobs with little concern for a suitable outcome for the patient. Choose your surgeon very carefully.
 

Beware of older techniques

Some common practices such as cartilage removal without reinforcement can lead to unsatisfactory results in the medium or long term and sometimes even the short term. Most patients want a natural looking nose so avoiding some of these older techniques is extremely important.
 

Changing your appearance

Bear in mind that any change to a part of your nose changes the proportions to all the other parts. Be wary of asking just to have your bump removed and be wary of a procedure or surgeon who wants to do only that. This is the easiest part of the operation but refining and making other parts match is equally important and usually but not always required. Revision rhinoplasty is even more complicated.
 

Open Tip Rhinoplasty vs Closed Tip Rhinoplasty

There are two commonly talked about techniques open or closed. Open means a small incision is made across the columella and then the skin is lifted backwards revealing the entire architecture of the nose. This gives the best exposure and allows a greater number of manoeuvres to be carried out with great precision and under direct vision. Many surgeons outside of the US still practice closed rhinoplasty and advocate it as a technique keeping all the incisions inside the nose.
 
Most surgeons practice one or the other once they are familiar with the procedure. The debate on the best technique continues and enthusiasts from either side claim superiority.
 
However, as always both sides have their point and thats why I offer both types of surgery. Limiting scars to the inside has advantages but the scope for creating a shape change and precision is more limited. On the other hand the scar across the columella is so well hidden that in many cases it is worth it for the exposure and vision the surgeon gets.
Much work has been done on the ideal shape and proportions of a nose and adhering to these certainly improve outcomes. This alone however is not enough. It is certainly not the case that one shape fits all, other facial proportions must be taken into account as well as race and ethnicity.
 

Rhinoplasty Augmentation

A less talked about technique is Augmentation Rhinoplasty. This is when tissues is added to the nose to enhance and redefine the proportions of the nose by adding volume. This principle has been picked up by non surgeons (and surgeons) who practice non surgical rhinoplasty by injecting filler to change the shape of a nose. Using filler is of course only temporary but I find it very useful to demonstrate to patients what can be achieved with augmentation prior to performing a more permanent correction. I use soft tissue, bone or occasionally implants to do this.
 

Rhinoplasty surgery and recovery times

I do Rhinoplasties under general anaesthetic and most patients spend one night in hospital. The splint is removed at about one week following surgery and most patients are back working and socialising at 2 weeks and back doing sport at 6wks. The amount of bruising and swelling you will have depends largely on how much work is done internally especially with regard to the nasal bones
 
 

Rhinoplasty Q&A - Your Questions Answered

What is the best technique. Open or closed Rhinoplasty?

That depends on what is being done to your nose internally. Often surgeons will believe that one technique is better than the other and to a large extent this depends on the surgeon's experience. I perform both types of rhinoplasty and it depends on which changes we are planning, as to which technique I suggest. As a general rule the more complicate the changes or the more refinements planned to the tip the more likely I am to plan an open tip rhinoplasty.
 

Can I have a rhinoplasty under a local anaesthetic?

The answer to this is yes. However I would not recommend it. In some places it is done with local anaesthetic and sedation. This makes it cheaper but in my view more risky. It means it can be done in a less well equipped environment and it also means your airway is less protected from post nasal bleeding. This can be life threatening and certainly compromises the procedure.
 

Do I need a General Anaesthetic to have a rhinoplasty?

For the same reasons as outlined above, a general anaesthetic is often preferably to ensure the very best surgical outcome and protection of your airway during surgery.

Will my nose look done or fake after a rhinoplasty?

The key to successful natural looking outcomes is balance. I specialise in natural looking enhancements and corrective surgery. Your outcome will depend largely on your choice of surgeon, their experience and the techniques they use.
 

My nose is not too big can I still have a rhinoplasty?

Yes. Many alterations are possible without making your nose smaller, a change of size is just one alteration that I offer. Most people ask for a reduction in size which is why most websites and articles focus on this, however this is not necessary unless you request it as part of the overall surgical outcome you are looking for.
 
 

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