Patient question:

I have consulted with a few surgeons regarding Rhinoplasty in Toronto. One surgeon told me that the surgery would take three hours and be an open Rhinoplasty; the other surgeon told me it would take forty minutes and be a closed Rhinoplasty. Why do they have such a different approaches to my surgery?

Dr. Solomon Answer:
This should not be construed as medical advice. I am a Board Certified Facial Plastic Surgeon and Otolaryngologist Head and Neck Surgeon.
Thanks for the question. Regarding Rhinoplasty surgery, there are two main types of surgery that can be performed. The open procedure involves a small incision under the collumella and involves lifting the skin off the underlying structures. This approach offers excellent exposure for the surgeon. The downside is the small incision, which generally heals up well. Other potential disadvantages can include increased swelling after surgery, with possibly increased down time. Surgeons who like this method generally feel the disadvantages are not significant and the advantage of increase surgical exposure justifies its use in many cases. Closed Rhinoplasty surgery involves making all incisions and changes to the nose through the inside of the nose. This technique has less exposure, but can generally achieve the same results in expert hands. Each surgeon has their own preference, based on their training and experience in practice.
The time of surgery varies, based on the complexity of each case, the method selected, and the surgeons surgical speed. The speed of surgery does not correlate to a good or bad result; if a surgeon tells you a much shorter procedure time, it is possible that they are planning a more limited or conservative operation. It is best to review with your surgeon what the goals of surgery are and that you are satisfied: all issues are being addressed to your satisfaction.
I offer both types of Rhinoplasty and try to decide on a case by case basis the best method to use. In situations involving a severely crooked nose, revision Rhinoplasty surgery or a complicated nasal tips surgery, I prefer to offer an open Rhinoplasty. In cases that have nice tips and mostly require a reduction in the bump or width of the nose, I would tend to prefer closed Rhinoplasty surgery.

Jul 11th 2007