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Closed Two-Section Rhinoplasty

This is a refined single nasal implant surgery. Though it also uses autologous ear cartilage to enhance the nasal tip definition, the whole procedure and results are different from those of the exquisite open (Korean-style) rhinoplasty. It is usually an alternative surgery for patients who do not accept an open incision at the columella but still expect a better shape and projection of the nasal tip in conjunction with the nasal bridge augmentation. In brief, it is conducted by the augmentation of the nasal bridge with an appropriate nasal implant (silicone or Sili-Tex) and concurrent autologous ear cartilage to elongate or support the nasal tip; therefore, it is also called closed two-section rhinoplasty. The surgical incision is made in the bilateral nostrils, which enables the limited dissection or suturing of the nasal tip structure. Moreover, since there is no cutting at the columella, the nasal tip skin cannot be completely separated and released from the deep structure, which induces a high tension or pressure over the nasal tip. Therefore, attention should be paid to avoid excess elongation of the nasal tip, and the transplantation of ear cartilage should be simultaneously performed to buffer the contact of the nasal implant with the skin. Otherwise, problems such as nasal tip skin thinning, excess tightness, or poor wound healing may occur. Models of nasal implants are selected based on individual conditions or requirements, and the common ones available are type I or L.

Surgical conditions

Duration

0hr
  • Type of anesthesia: IV sedation + local anesthesia
  • Surgical incision: Approximately 1-cm incision in the bilateral nostrils
  • Recovery: 3–5 days
  • Removal of stitches: No

General instructions

Do not smoke for 1 week, and fast from food and water on the day of operation

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  • Wear a tape for 1 week postoperatively to fixate the nasal bridge.
  • Avoid smoking and alcohol for 3 months postoperatively, and avoid impacts to the nasal bridge. Clean the intranasal wound in the morning and evening every day.
  • Try to avoid raw food, seafood, and spices for 3 months postoperatively.

Ideal candidates

  • Patients with normal conditions who desire to improve the height or projection of the nasal tip by closed rhinoplasty.
  • Those who desire to elongate the nasal tip but cannot accept the relatively complex open rhinoplasty or columella incision.
  • Those who have a scar tendency and cannot accept the wound from columella incision.

Potential complications

  • Implant deviation, cartilage transposition, infection of the nasal implant
  • Enlargement or tightening of the nasal tip
  • Foreign body reaction or poor wound healing
  • Results short of expectation

Surgical advantages

  1. No scar is left as the incision is intranasal.

  2. It is less likely to cause an excessively sharp nasal tip or the presence of white spots due to single nasal implant emplacement.

  3. It provides better results than a single type I or L nasal implant augmentation due to the elongation and support of the nasal tip by the ear cartilage graft.

  4. The nasal tip has a relatively soft texture and twists freely after the surgery.

  5. The cost and results are moderate.

Surgical drawbacks

  1. Because there is no incision at the columella, it brings about inferior results in nasal tip elongation compared with those of open rhinoplasty and limited effects on upturned nose or nostril exposure correction.

  2. Limited suturing of the intranasal cartilage shows insignificant results in the reduction of the nasal tip.

  3. The nasal tip may become broad due to the emplacement of the ear cartilage.

  4. The ear cartilage cannot be fully fixated after emplacement via an intranasal incision and may shift or be absorbed in the future.

  5. An additional scar may be left posterior to the ear due to the harvest of the cartilage.

Possible procedure in conjunction

Before & After

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

Closed Two – Section Rhinoplasty