Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R Palmer, III Beverly Hills Plastic and Cosmetic Surgeon.

+�-�+�-� +�-�I’ve had numerous Rhinoplasty and Revision Rhinoplasty consultations, this week, where the patiens seemed confused about when an Open Rhinioplasty should be done versus a Closed Rhinoplasty…so I though this would be a good time for a brief review of the subject.

+�-�+�-� In my opinion, you should avoid a Rhinoplasty surgeon who makes claims like “I only do Open Rhinoplasty…or I only do Closed Rhinoplasty.”+�-� Why?….because both are viable and important techniques of Rhinoplasty and the surgeon should be able to do both…but select which one is the right technique in your particular case.

+�-� When I’m teaching Rhinoplasty to surgical residents I tell them to keep it simple.+�-� Open Rhinoplastry is indicated, in my opinion, when there is a very droopy tip as this technique causes a minimum of 5-7 degrees of tip rotation everything else being equal.+�-� An Open Rhinoplasty therefore would not be appropriate if the nasal tip was already at the ideal rotation or over-rotated…and if performed would require an additional procedure to place an ear grfat to the nasal tip to rotate the tip back down to the aesthetically correct position.

+�-�An Open Rhinoplasty should always be considered when the nasal tip is asymmetric, previousy operated on (previous Rhinoplasty) or otherwise requires the placement of a cartilage graft to the nasal tip.+�-� Why?…because an Open Rhinoplasty allows visualization of the tip cartilages as they exist in the nose, allows direct manipulation of these cartilages and allows securing/suturing of the cartilages and/or cartilage grafts under direct visualization….a Closed Rhinoplasty does not!

+�-� A Closed Rhinoplasty is indicated for all other issues with the nose…large hump, placement of a dorsal graft, breaking the bones etc can all be done without an Open Rhinoplasty.

+�-�The small ioncision along the front of the nose is never a reason, for me, to do or not do an Open Rhinoplasty.

+�-�Hope this helps.

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Dr. Francis R Palmer, III

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