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Semi-Open Rhinoplasty: Getting Together The Best of Both, Open and Closed Rhinoplasty
Semi-Open Rhinoplasty: Getting Together The Best of Both, Open and Closed Rhinoplasty
Semi-Open Rhinoplasty: Getting Together The Best of Both, Open and Closed Rhinoplasty
© All rights are reserved by Dr. Marcos Quispe Jorge Luis, et al.
Abstract
Summary: Rhinoplasty is one of the most common procedures of our surgical practice. According to the approach, it can be open or
closed; however, the semi-open approach has been recently incorporated. Semi-open rhinoplasty allows the dissection and complete
exposure of the alar cartilage, similar to the open approach, but the incision is limited to the nasal vestibule without a transcolumellar
scar, just as in the closed approach.
The objective of this work is to describe the surgical technique and show the outcomes.
Material and Methods: We evaluated 376 patients who underwent primary and secondary rhinoplasty with the semi-open technique,
performed between June 2016 and June 2019.
Results: In this period, we performed 376 rhinoplasties with the semi-open technique; 340 (90.4%) patients underwent primary rhino-
plasty and 36, secondary; most of our patients were women (73.1%), both, in primary (72.4%), as in secondary rhinoplasty (80.6%). To
address the nasal tip, we performed mainly domal suture and columellar graft in 48.9% of the patients, followed by domal suture,
columellar graft, and nasal tip graft in 30.3%, and in 20.8%, we shaped the tip with domal sutures.
Conclusion: The semi-open technique provides a wide exposition of the nose, to successfully address and modify the osteocartilaginous
nasal structure, especially the nasal tip, thus obtaining predictable results.
Keywords: Rhinoplasty; Semi-open rhinoplasty; Primary Rhinoplasty; Septorhinoplasty.
Introduction and length of the incision in the columellar skin. Also, Sevin et al. [4],
Bruschi et al. [5], Cardenas et al. [6], Kamburoglu et al. [7] published
Rhinoplasty is one of the most common procedures of our surgical successful results with the technique described. The term semi-open
practice. According to the approach, it can be open or closed. The rhinoplasty was introduced by Inchingolo et al. [8] in 2012, who
open rhinoplasty provides a wide exposure of the nasal structures, to reported some cases he operated on, using the technique published by
clearly identify defects, and correct them under direct vision. However,
Guerrerosantos.
the transcolumellar scar can alter the final aesthetic results, especially
in non-caucasian patients. On the other hand, the closed rhinoplasty In 2014 we began performing this approach for the primary
limits the incision only to the nasal vestibule without a visible scar. treatment of the nasal tip, instead of the “delivery" technique; soon it
Thus, this narrow exposure of the osteocartilaginous vault, makes became our first surgical option for both, primary and secondary
difficult the handling of the structures, especially those of the nasal rhinoplasty, choosing the closed one with intracartilaginous incision for
tip. some select primary cases, and the open for particular secondaries. The
objective of this work is to present the surgical technique and show our
Semi-open rhinoplasty technique allows wide exposure of the alar
results.
cartilage, as in open technique, with the incision placed in the nasal
vestibule with no transcolumelar scar. This technique, previously Material and Methods
known with another nomination, was published in 1990 by Dr. Gue-
We evaluated 376 Patients who underwent primary and seco-
rrerosantos [1], as a technique of "Open rhinoplasty without skin-
ndary rhinoplasties, with the semi-open approach, from June 2016 to
columella incision," later Holmstron in 1996 [2], and Bravo & Schwarze
June 2019, patients having only closed or open rhinoplasty were
in 2008 [3] published a similar technique with a slight variation in shape
excluded. The database was checked to obtain the list of patients
operated on with the technique described and collected their medical
records and the photographic album.
*Address for Correspondence: Dr. Marcos Quispe Jorge, Plastic Surgeon, Surgical Technique
Manuel Olguín Street N° 970 – 19, Santiago de Surco, Lima, Perú. Postal
Address: 15023, E-mail: drjorgemarcos@gmail.com With the Patient under intravenous sedation, we block, the infra
and supraorbital nerves with lidocaine and epinephrine1/200000 with
Received: April 24, 2020; Date Accepted: May 29, 2020, Date published:
June 01, 2020. local troncular anesthesia, we continue the tumescent infiltration into
the submucosal plane of the nasal vault, and subcutaneously the nasal
tip and base. We wait for the anesthesia effect for 10 minutes and
proceed with the infracartilaginous incision 1 mm from the lower
margin of the alar cartilage: from medial to lateral in the lateral crus,
from top to bottom at the edge of the medial crus along the columella,
and the incision is completed at the level of the domes, carefully to
avoid injuring the area of the soft triangle [Figure 1].
Figure 3: The semi-open technique shows up widely the alar cartilage; to trim
and reshape the nasal tip by placing sutures: Interdomal, transdomal,
intercrural, septocolumellar. (left) If needed, we can use a columellar graft; it is
placed between the medial crurato provide support and projection to the nasal
tip (right).
Results
In the period studied, 376 rhinoplasties were performed with the
semi-open technique: 340 (90.4%) were primary rhinoplasties and 36
cases secondary, the majority of them in women (73.1%); both:
primary rhinoplasty (72.4%), as secondary (80.6%), as referred in
[Table 1]. To address the nasal tip, we performed mainly domal
sutures and cartilaginous graft (columellar and or nasal tip) in 79.2%
of all our patients. Only in some of them 20.8% we used exclusively
domal sutures.
Table 1: Demographic features and nasal tip procedures when performing
Figure 2: To facilitate dissection and handling, we link the domes with black semi-open rhinoplasty.
silk 2/0, to pull them to correct osteocartilaginous defects (Left). Thus, we
Primary Secondary
laterally retract the alar cartilage, and with the double hook, we expose the Rhinoplasty Rhinoplasty
posterior aspect of the cartilage,and insert spreader grafts (right). Total
Men Women Men Women
Next, we check and do the corrections needed, trim the dorsum,
Cases 94 246 7 29 376
and go back to the nasal tip; according to the surgical plan, we first
place spreader grafts [Figure 2], go on with the resection of the cephalic Age 17 - 52 y 15-53 y 23-62 y 21-57 y
edges of the lateral crus, then we put transdomal sutures with 5/0
prolene, remove the traction stitch from the domes. We evaluate the
Domal Suture 23 51 0 4 78
shape and projection of the domes in their natural position; then we
transfer the markings to the other nostril. In that position, we put a
Domal Suture + 57 117 2 8 184
columellar graft [Figure 3] or a septal extension graft, according to Columellar strut
the individual nose evaluation, it is fixated with stitches. Then, we
Domal Suture + 14 78 5 17 114
proceed with intradomal, transdomal, and or interdomal suture Columellar strut +
[Figure 4], and at the end of this step, place nasal tip grafts if needed Nasal Tip Graft
[Figure 4]. Finally, we perform internal and or external osteotomy
using 2mm chisel, suture the nasal mucosa with chromic catgut 4/0,
and end with splinting.
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