Question: Are there different techniques for achieving an excellent result in rhinoplasty?
Dr. Rohrich: Yes, there are different techniques. However, it is not so much about the technique used as long as that particular technique delivers the desired result. The nose is the most looked at facial feature so it must not shout out rhinoplasty.
The main different techniques are open vs. closed rhinoplasty. I prefer the open technique in most cases. This means you make a very small 6 mm incision in the middle of the columella (the structure in the middle of the bottom of the nose). This procedure allows the surgeon to look directly at the nasal deformity, while with the closed approach he has to do everything in a blind way, so to speak, which means he doesn’t have the same level of control.
And rhinoplasty is all about controlling every aspect of the procedure…
In the open approach, the surgeon can see the deformity and correct it with the patient’s own tissue – and reshape the cartilages using sutures and/or invisible grafts. With the open approach, the nose looks more natural longer and ages well with the patient, without the need for revision in most cases.
In the closed approach the surgeon has to use more grafts as it is impossible to see the deformity – so, instead of correcting it, the surgeon has to camouflage it. Not the best thing to do long term as visible grafts can become distorted with time.
Rhinoplasty is a surgical procedure of millimeters. It is the most precise technique in cosmetic plastic surgery, therefore if you are off by a millimeter one way or the other you can have either a great or phenomenal result or a poor outcome.
Rhinoplasty, in fact, epitomizes plastic surgery as a whole because it is a surgery of such great finesse and three dimensional thinking and execution, as well as precise pre-op planning – all of which require constant learning and take years to master if you truly want to be a real expert. Experts are not born but are made through tireless learning, critical self-analysis and always seeking a higher level of excellence. It takes an average of about 10 years or 10,000 hours to become a true expert in anything in life!