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Rhinoplasty Surgery Blog
Bora Ok, MD.

Why we prefer Closed Approach at Ethnic Rhinoplasty Surgery ?

Dr. Bora Ok prefers Closed Approach in Primary Rhinoplasty. The closed rhinoplasty method applied by Dr. Bora Ok, involves the total dissection of the nasal tip cartilages and the application of stitching and grafting techniques known to be performed in the open rhinoplasty. In this way, we can make the changes that we want at the tip of the nose. But this approach needs experience. Therefore, it is easily applied by experts with long-term closed rhinoplasty experience. Of course, this approach can be difficult at the beginning for the ones whose are used to do open rhinoplasty surgery.

  1. The patients who were treated with Ethnic Rhinoplasty are generally thick skinned and african-origin dark skin. Insicion at the columella can heal so well in some patients but especially in darker skin it may prone to hypertrophic scar which may distrurb. In Closed Rhinoplasty approach this possibility is completely eliminated.

  2. In Open Rhinoplasty, with the incision made in columella, the vessels feeding the nose tip are interrupted and the blood flow towards the nose tip is reduced. This causes more swelling and stiffness during the healing process. (Look at the below for Figure-1)

  3. Columella has a perfect and unique anatomy, and each millimeter of skin has different thickness along the columella. Especially in the Ethnic Rhinoplasty, the upper and lower part of the insicions can be seem more prominent. This may cause a notching view at the incision line. In Closed Rhinoplasty, you feel that all the features of the unique structure are protected when you touch your collumella also it guarantees a smooth columella as an image. (Look at the below for Figure-2)

  4. At the same time, especially when the nose needs to be extended and elevated, there maybe color changes at the nose tip due to the decrease in blood circulation.

  5. In Ethnic Rhinoplasty, many patients' wing of the nose (alas) need to be cutting. Therefore, nasal tip blood circulation decreases both by cutting veins in columella and by cutting the vessels from alas to the tip. This increases the problems such as late recovery and edema due to circulatory disorders.

  6. In Open Rhinoplasty, more cartilage grafts and sutures are required to restore nasal stabilization at the end of the operation when the nose is fully released and opened. This may lead to greater stiffness at the tip of the nose, prolonged edema and also possible stitch reactions.

  7. Defatting may be necessary to provide a more contoured nasal tip, especially for people with thick skin and a prominent fat layer under the skin. In closed rhinoplasty, it is safer to apply this thinning process because the vessels in the columella are protected. In open rhinoplasty, necrosis (tissue death) is more likely to be seen in the skin of the region as a result of this procedure especially when aggresive defatting performed.

  8. Bridge Augmentation is one of the important steps in Ethnic Rhinoplasty. In Closed Approach we can dissect the bridge of the nose meticoulusy not large or not too small and this help us to place dorsal grafts to the bridge precisesly and also this kind of approach needs less stabilization technics then open rhinoplasty approach also results with less swelling and faster healing. Creating pockets for grafting is one of the good advantages of the closed rhinoplasty it also hepls less stitching and grafting.

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Dr. Bora Ok is a member of the International Society of Aesthetic Plastic Surgery (ISAPS) and American Society of Plastic Surgeons (ASPS) He has 13 years of surgical experience.

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