Sunday, November 13, 2016

Open vs. Closed Rhinoplasty: Philadelphia’s Dr. Greco Explains

Out of all of the cosmetic surgeries and treatments available to help patients achieve a more ideal aesthetic version of themselves, perhaps none so closely marries form and function as the rhinoplasty. Philadelphia facial plastic surgeon Dr. Timothy Greco regularly sees both men and women who desire their nose to have better compliance with their face, and while that can be done in what is typically a straightforward and quick single surgery, there is nothing simple about the procedure. The nose, after all, is more than a prominent central feature on the face. Its proper functioning allows for unobstructed breathing, while humidifying and moisturizing the air.

As the nose is made up of several different parts, each interacting with the others in a complex mix of planes and angles, there is no single rhinoplasty surgery that can accomplish every patient’s goal. One person may want narrower nostrils, while another may want a nasal hump contoured to complement other facial features. Certain patients desire smaller, less obtrusive noses in general, while others complain of asymmetry, which can indicate internal structural problems that impede breathing. Each problem calls for a unique solution, as well as understanding of how the changes will impact the nose—and face—as a whole.

For most problems, the technique employed is known as an “open rhinoplasty.” This gets its name from the fact that tiny incisions, including one made across the small strip of tissue that separates the two nostrils, allows the nasal skin to be lifted away, “opening” the nose to reveal its internal structures, giving the plastic surgeon a clear view of the anatomy and allowing direct access to the tissues to be repositioned, reshaped, or removed.

With the internal work completed, the skin is draped onto the nose again and sutured into place. When working with a surgeon who practices advanced techniques, the resulting incisions heal inconspicuously, hidden in the natural lines of the nose.

Another technique, the “closed rhinoplasty,” keeps all incisions inside the nose where they can’t be seen. This method further cuts down on the already minimal visibility of any resulting scars, which appeals to some patients, though it also cuts down on visibility and provides more limited access to the nasal structures throughout the surgery.

Whether a patient can get the desired results via a closed or open rhinoplasty can be determined during the consultation, which should also provide an opportunity for any questions about the surgery to be answered.

Dr. Greco also educates his patients on a procedure known as a “septoplasty,” which straightens a deviated nasal septum, often the cause of both breathing difficulty and cosmetic dissatisfaction.

Another variation on rhinoplasty is “revision rhinoplasty,” which is more involved than correcting a primary cosmetic irregularity. Unwanted results from a prior nasal surgery can create structural deformities that impact both form and function. The techniques unique to this surgery may involve harvesting tissue from elsewhere on a patient to restore structural support lost when too much bone or cartilage was removed by another doctor. Donor cartilage may come from the septum within the nose, the ears, or the ribs, a generally less-common technique undertaken only by select doctors who have extensively studied the method and successfully practiced it for years. Dr. Greco has extensive experience with rib harvest rhinoplasty and has lectured extensively on the topic.

The key to a successful rhinoplasty, whether open or closed, primary or revision, is to choose a plastic surgeon who appreciates the aesthetics of the nose and face to allow for the final result to truly complement the rest of the face.  An ENT (otolaryngology) background as well as a facial plastic surgery background places Dr. Greco in a uniquely qualified position to operate on the nose to create an aesthetic result and also a well-functioning nose.

Discover more about both open and closed rhinoplasty from Philadelphia-area double board certified facial plastic surgeon Dr. Timothy M. Greco. Contact his Bala Cynwyd office by calling (610) 664-8830, reaching out online, or visiting

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