From the Guidelines
A scarless rhinoplasty is not necessarily better than traditional rhinoplasty, as the choice between the two depends on the patient's specific needs and goals, with the most recent evidence suggesting that traditional rhinoplasty may offer better outcomes in terms of morbidity, mortality, and quality of life 1. When considering rhinoplasty, it's essential to weigh the benefits and limitations of both scarless and traditional approaches. Scarless rhinoplasty, also known as closed rhinoplasty, involves making incisions inside the nostrils, which can result in no visible external scars. However, this approach may limit the extent of possible modifications due to reduced visibility of nasal structures for the surgeon. On the other hand, traditional (open) rhinoplasty involves a small incision across the columella, which typically heals well with a barely noticeable scar. This approach provides better access and visibility for more complex nasal restructuring, which may be beneficial for patients requiring extensive structural changes. The recovery time for both techniques is generally similar, involving 1-2 weeks of noticeable swelling and bruising, with residual swelling that can last months. Ultimately, the best approach depends on the complexity of changes needed, with minor tip or bridge adjustments potentially suitable for closed rhinoplasty, and more extensive structural changes often requiring the open technique. It's crucial for patients to discuss their specific aesthetic goals with a board-certified facial plastic surgeon who can recommend the most appropriate technique for their individual case, taking into account the potential risks and benefits of each approach, as well as the patient's overall health and well-being 1. Some key points to consider when deciding between scarless and traditional rhinoplasty include:
- The extent of modifications needed to achieve the desired outcome
- The potential risks and benefits of each approach
- The patient's overall health and well-being
- The surgeon's expertise and experience with both techniques By carefully evaluating these factors and discussing their options with a qualified surgeon, patients can make an informed decision about which approach is best for their individual needs and goals.
From the Research
Scarless Rhinoplasty
There is no direct evidence to suggest that a scarless rhinoplasty is better. However, the provided studies discuss the challenges and complexities of revision rhinoplasty, which may be relevant to the topic.
Revision Rhinoplasty Challenges
- Revision rhinoplasty is a difficult operation to perform, with high re-revision rates, as reported by 2 and 3.
- The complexity of revision rhinoplasty is increased due to the need for extranasal grafting material and complex reconstructive techniques, as noted by 3.
- The occurrence of another revision during the follow-up period is significantly higher after revision surgery compared to primary rhinoplasty cases, as found by 3.
Surgical Approaches
- The open approach is often advocated for revision rhinoplasty, as it provides better visualization and access, enabling the surgeon to achieve treatment goals in a more predictable fashion, as suggested by 4.
- The choice of surgical approach and techniques depends on the individual case and the surgeon's experience, as discussed by 2 and 4.
Patient Selection and Preoperative Planning
- Detailed preoperative assessment is crucial for proper patient selection and to agree on the goals for and risks inherent in revision rhinoplasty, as emphasized by 5.
- A precise preoperative surgical plan minimizes intraoperative misadventures, and options for grafting materials should be discussed and agreed upon by both patient and surgeon preoperatively, as recommended by 5.