This is one of the most confusing issues for rhinoplasty candidate patients. Doctors who perform open rhinoplasty say there will be no left, those who perform closed rhinoplasty say there will be. Well, both groups are doctors, they are not going to lie. If you are one of those who are confused about who to believe in this environment, this article was written for you.
First of all, what is a "mark", it is necessary to define it well. In plastic surgery, "scar" is the common name for all the physical signs that allow an outside eye to understand a surgery performed. When we say "scar" of surgery, we mean all the signs that the person had surgery. When we say "scar" in rhinoplasty, what we usually mean is incision marks due to skin or mucosal incisions.
Let's list these scars...
⦁ The tissue bridge (columella) that separates the two nostrils
A 4-6 mm long incision scar passing right through the middle.
This scar is the entry scar used when separating the nasal soft tissues from the skeleton in open rhinoplasty. We do not see this area of the nose when viewed from the front, so a trace here is outside our visual attention area in daily communication. Since the wound healing of this area is quite good, if it is stitched carefully, the thickness of the scar here will remain below 0.5 mm. During secondary surgeries, I have difficulty seeing these scars even when looking under bright operating lights with magnifying surgical glasses. On the other hand, if there is a level difference between the wound lips during stitching and if the very elegant tissue here is damaged with a rough technique, the scar may be visible and may need to be renewed in a second session.
⦁ The incision scar at the junction of the nasal skin and nasal mucosa on both sides of the columella. .
This scar corresponds to where the first scar above curves from the sides into the nose. In the open technique, this scar is limited to the upper half of the columella, whereas in the closed technique, when the cartilages are delivered and shaped outside, the scar often has to pass throughout the columella. If necessary care is not taken, this scar can be seen from the outside in patients who have had closed rhinoplasty.
⦁ In cases where the nose wings are reduced, the incision scar left in the groove where the wings and the cheek meet.
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If the nostrils or wings are large and these structures need to be reduced during surgery, it is impossible to do this without leaving a scar on the skin. This scar is the most obvious of the scars left on the skin after nose surgery. Whether in the open technique or the closed technique, if the wings are to be reduced in size, this scar will remain.
⦁ The incision marks left on the skin by the metal bone drills we call "osteotome".
One of the techniques used when shaping the bones in nose surgery is direct surgery. It involves shaping the bones through the skin with a very thin metal chisel. In this technique, called percutaneous osteotomy, incision scars as large as the thickness of the tool used (1-2 mm) may remain on the skin. Since this technique is preferred by some physicians who perform both open and closed rhinoplasty, these scars may occur after surgery in both techniques. On the other hand, these scars will be invisible after a 3-6 month healing process.
Depending on the techniques used in open rhinoplasty surgery, all of these 4 types of scars can be seen. On the other hand, these scars heal so gently when the appropriate technique is used that an outside eye cannot see these scars unless they get very close and examine them in a very bright environment.
What most people do not know is that the second, third and fourth scars can be closed rhinoplasty depending on the techniques used.
Therefore, the sentence "open rhinoplasty leaves a scar, but closed rhinoplasty does not leave a scar" is not entirely true.
Is it an incision scar or a deformity?
Nose If a person who does not know you at all and is sitting at the next table can tell that your nose has been operated on after the plastic surgery, it means that he/she is doing this by following some traces. If we were to list the post-operative problems that give clues to the observer that the nose has been operated on, the incision scars listed above would be at the bottom of this list.
The main problems that create the appearance of the operated nose are structural defects (deformity) in the nose. Closed rhinoplasty (Rhinoplasty) is a surgery that is more prone to post-operative structural disorders since it is performed without "visualizing" the skeletal and cartilage structure in the nose. For this reason, to avoid a trace that is almost impossible to see in daily life, the side table It is unreasonable for both the physician and the majority of patients to take into account structural defects that may appear from the rhinoplasty.
Due to these problems, modern closed rhinoplasty surgeons have searched for ways to perform some surgical maneuvers used in the open technique with the closed technique and have emerged with hybrid (semi-open) surgery techniques. has come out. Even these can be applied effectively only in a limited group of patients, not in every patient. Since most of the surgeons who are experienced in rhinoplasty today can safely apply both open and closed techniques, it will definitely be to your benefit to leave the decision to your surgeon in terms of choosing the appropriate technique for you.
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