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Surgical approach: Open vs. closed

Rhinoplasty can be performed under a general anesthetic, sedation, or with local anesthetic. Initially, local anesthesia, which is a mixture of lidocaine and epinephrine, is injected to numb the area and temporarily reduce vascularity.
There are two possible approaches to the nose: closed approach and open approach.
In closed rhinoplasty, incisions are made inside the nostrils and all the surgery is made through these incisions. Most of the surgeries are done with the closed technique, especially when removing a dorsal hump with or without reducing the nose width.
In open rhinoplasty, an additional inconspicuous incision is made across the columella (the bit of skin that separates the nostrils). Open rhinoplasty is indicated when important corrections of the tip of the nose must be done or when doing a secondary rhinoplasty. The surgeon first separates the skin and soft tissues of the nose from the underlying structures. The cartilage and bone is reshaped, and the incisions are sutured.
At the end of the surgery we place inside the nostrils vaselinated gauze that minimizes the bleeding after the surgery, tape over the nose and a stent or cast covering the nose for few days.
Depending on the case, we may shape a small piece of the patient's own cartilage or bone, as a graft, to strengthen or change the shape of the nose. Usually the cartilage is harvested from the septum. If there is not enough septum cartilage, which can occur in revision rhinoplasty, cartilage can be harvested from the concha of the ear or the ribs. In the rare case where bone is required, it is harvested from the cranium, the hip, or the ribs.

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