In this article I will talk about the Closed Atraumatic Rhinoplasty approach which is my special practice in rhinoplasty and I use in my clinical practice and in my scientific studies.
Closed Atraumatic Rhinoplasty
Closed rhinoplasty refers to a technique where surgical incisions are positioned inside the nostrils with no external scar to shape the nose. At this point, no incision or scar is created on the nose and the appearance of an “operated” or “surgical” nose is avoided. But the closed rhinoplasty technique should not only consist of preventing a scar on this skin. Then I need to immediately explain the meaning of the “Atraumatic” word here. The word “atraumatic” is a Latin word which is designed to minimize tissue damage and means not causing injury or trauma. This is a surgical philosophy that can be adapted to all surgeries. Because it answers the question of how to operate the most gentle, kindest and without harming anything. And this philosophy is valid for every stage of surgery. Since the incision on the nose may cause a scar, “Atraumatic” philosophy determines rhinoplasty as closed rhinoplasty technique.
For example; To remove bump in nose we can get through the nostrils and reach nasal bone. While doing that we can do it with under the skin/fascia plan which will cause damage on blood vessels and will create more edema and brusing after the operation or with a submembranous dissection plan which will give us the opportunity to not cause any damage on blood vessels.
Another example; there is a dropped nose tip and we want to lift it. While doing this if we can protect pitanguy ligament, we can ensure that tip of the nose does not lose its flexibility and sensibility.
One last example; there is an excessive cartilage at the tip of the nose and it makes the nose look wider. Instead of cutting this cartilage, it may be possible to fold this cartilage to make the nose both narrower and stronger. It is possible to give many examples like these.
In other words, Atraumatic Technique is a progressive approach that changes every step of the surgery and looks for how to do without harming anything as desired.
As you can tell from what I have told, the fundamental and important thing is the Atraumatic Approach. Closed rhinoplasty technique was preferred by me, because it helps atraumatic approach. As a result, Closed Atraumatic Rhinoplasty is the result of an effort to do your best.
Closed or Open Rhinoplasty Technique?
Closed rhinoplasty is my specialty and I continue to work with my scientific publications on this subject. In this article I will tell you what closed rhinoplasty means, its history, and recent developments. Rhinoplasty was first performed in America during the 1st World War to the actor and actress and the surgical incisions are positioned inside the nostrils to rasp bone. Then it became increasingly popular and has become what it is today. Thus, the first rhinoplasty was planned with the closed technique which does not contain any incisions from outside.
Later, the open rhinoplasty technique has been found easier and more feasible by surgeons and became popular during the past 30 years. In this technique (open or external rhinoplasty approach), a bridging incision was created, called a trans-columellar incision, to connect the right and left nostril incisions. The nasal skin can be folded upward and so can be focused to the bone and to the cartilage. The field of view can be seen directly without using any special instruments and can be taught to assistants easily in terms of vocational training.
The closed rhinoplasty had become popular again lately with the development of many special tools such as camera systems like endoscopes and micromotors. Special courses, conferences, and publications have been organized for the surgeons to expand this difficult technique.
Why is it important to cut or not cut the skin? This question is one of the discussion topics in all rhinoplasty congresses. Proponents of the closed rhinoplasty technique emphasize that since there is no incision on the nose or on the pitanguy ligament; there is no scar, the nose returns quicker to a normal appearance and the tip of the nose does not lose its flexibility and movability. And since the nasal skin is not folded upward, so the place where the skin is placed can be seen. On the other hand; proponents of the open rhinoplasty techique emphasize that after the incision on the nose, a disturbing or noticeable scar will not stay. And since the nasal skin is folded upward, it is easy to see inside and since it is more watchable, it is used for educational purposes to the assistant surgeons.
I can use both closed and open rhinoplasty approach, based on the patient’s rhinoplasty indications. In my clinical practice, I perform all operations with closed rhinoplasty technique. In closed rhinoplasty technique, the surgery is performed with the surgical incisions which are positioned inside the nostrils.