Typically, the skin is lifted away from the underlying cartilage and bone. Many precise surgical maneuvers are then possible, depending upon the goals of the operation. If there is a bump on the bridge of the nose, then the cartilage and bone are filed down so it becomes straight and flat. If it is too wide, then the nasal bones are brought closer together. If the tip is too big and round, then fat and cartilage are often removed, and sutures are placed to help make it narrower. If the nose sticks out too far, then the cartilage is collapsed upon itself and sutured to set it back.
THE DIFFERENCES BETWEEN A CLOSED & OPEN RHINOPLASTY
Depending upon your goals, Dr. Sieffert may perform a “closed” or “open” Rhinoplasty. During closed Rhinoplasty, incisions are made inside the nostrils and the nasal bones, cartilage and soft tissues are often manipulated without direct vision. Open Rhinoplasty is the most popular approach in the United States. The addition of a 2–4 millimeter incision across the skin of the columella (strut between the nostrils) allows reshaping under direct vision. This subtle difference has improved predictability and reproducibility for most surgeons
Dr. Sieffert performs these procedures on an outpatient basis under general anesthesia. The patient goes home with a small, skin-colored external cast or splint in place and there is no internal packing except in rare circumstances. The cast or splint is removed after one week, and discomfort is controlled with oral medication. External sutures are removed at one week as well, and internal sutures dissolve.