Rhinoplasty Technique

Dr. Schwartz is adept at utilizing both closed and open rhinoplasty techniques.

There are two approaches to rhinoplasty known as the closed approach and the open approach. Really the only difference is making a small notched incision on what is called the columella, which is the central portion of the underside of the nose. This enables the surgeon to lift the skin up and visualize the cartilaginous framework of the nose directly without what we call delivering the cartilages or working through close spaces. I really use the open approach only about 10% of the time. I do about 90% of my noses closed. The open approach is more useful for especially difficult situations in the tip such as a revision surgery situation where grafting needs to be done, but again, most of the time, I can achieve the grafting but I need to do through the closed approach. At any rate, whether or not that incision is used, it is closed so carefully that it is really virtually undetectable, so it is not an issue. I believe rhinoplasty is one of the hardest cosmetic surgery procedures to perform. The reason for this is that the anatomy of the nose is very complicated, even though it looks like a simple little blob sitting on our face, it is really not. There is a lot going under there and what happens is during the surgery when someone is asleep, the nose is injected with local anesthetic solution, which kind of distorts the fine detail of the nose, so the surgeon has to understand what changes are being made at the time of surgery and how these changes will impact the result.