What is Scarless Rhinoplasty? (Open vs. Closed  Rhinoplasty)

Many cosmetic surgeons have adopted an open technique for rhinoplasty—the open technique means a scar is place across the columella which is the skin between your nostrils.  I strongly disagree with the routine or even occasional use of this open technique.  Although the practitioners of this technique typically claim that the scar is insignificant, it is frequently quite noticeable and all too often deforming.  Have you noticed a scar on this area on close ups of models or movie stars?  Of course not because it is a beautiful part of the nose and you should not have this skin adulterated.

I have seen excellent surgeons get excellent results with this open technique—and I am personally convinced that these same doctors would get great results with the scarless technique as well.  As a matter of fact, I have followed the careers of some plastic surgeons who got just as good or better results before they began to cut open the nose.

So why do some surgeons cut the columella sand leave this potentially obvious scar?  Some do so because they are teaching residents to learn the anatomy—unfortunately, the residents may only learn this open approach and never learn how to work with the anatomy using the traditional scarless approach.  Some doctors feel they can get a better result with the open technique, however I think a poor rhinoplasty surgeon is going to get a poor result independent of the approach.

I was trained to do both the scarless rhinoplasty (closed rhinoplasty) and open rhinoplasty, but I have reserved the open technique for only the most rare of difficult noses.  I do 99% scarless rhinoplasty.  I believe my results without a scar in the center of the nose are equal to or superior to those that can be attained by an excellent surgeon using the open (scar) technique.

By the way, there is a scar that all plastic surgeons must use (both practitioner of open and closed techniques).  Whenever we need to narrow the nostril, which is only done when the nostrils flare widely, we must make an incision in the crease where the nostril meets the cheek.  This of course is different from the scar across the columella that I discussed above.

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