Q: I have wanted to have a nose job for a long time. I have very broad nasal bones and a big bump. I really like my tip however. I went to see a doctor and he told me he would do a rhinoplasty with the open technique. It doesn’t seem logical to me, what is your thought?
A: Good thought! Someone like yourself who likes their tip and has a problem with their bump and the width of their bones does not need to have an open rhinoplasty.
The problem now is that there are many physicians who do not know the endonasal (closed) technique. Because of their lack of training or their inability to do the endo nasal technique, many patients undergo an unnecessary procedure that changes the patient’s nasal tip. While many physicians who use the open rhinoplasty technique have great results, one technique does not fit all patients.
In order to approach the nose with an open rhinoplasty technique, the skin is elevated over the entire lower cartlidges. In doing so, many of the structures that support the tip are destroyed and then need to be reconstructed. If a patient does not have a problem with their tip and does not want to change it, an open rhinoplasty technique is not indicated.
My suggestion is that you go get a second opinion from a facial plastic surgeon or plastic surgeon who does many rhinoplasties. In addition, make sure that you ask the doctor to show you before and after pictures and that you are comfortable with the results that they show. Generally, your physician will show you their best pictures of rhinoplasty operations, which their patients allow them to show. If you are not happy with the way those pictures look, you should discuss this with your doctor prior to having surgery or seek a second opinion.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at Cwolf@miamiplasticsurgery.com. Follow him at @CarlosWolfMD.