Dr. Buonassisi Talks About 4 Iffy Rhinoplasty Requests

<h2>What Should You Know About Open vs. Closed Rhinoplasty?</h2> <p>Many patients come to our clinic with a preference for closed rhinoplasty, often without fully understanding what it entails. Closed rhinoplasty is a technique where all incisions are made inside the nostrils, leaving no visible scars. However, this approach may not always be the best option for achieving the desired results. Dr. Buonassisi emphasizes that the choice between open and closed rhinoplasty should be based on the specific needs of the patient rather than a preference for one technique over the other.</p> <p>In many cases, the complexities of nasal anatomy require the precision that an open rhinoplasty provides. This technique allows for better visualization of the nasal structures, making it easier to perform intricate maneuvers on the nasal tip and other areas. While some patients may fear that open rhinoplasty will lead to more scarring or swelling, Dr. Buonassisi reassures them that the differences are minimal and that the benefits often outweigh these concerns.</p> <h2>Why Do Some Patients Request Specific Surgical Techniques?</h2> <p>Patients often arrive at our clinic with specific requests for their rhinoplasty procedure, such as insisting on a closed approach. These requests may stem from misconceptions about the techniques, often fueled by information found online or through word of mouth. Dr. Buonassisi notes that many patients are unaware of the nuances between these surgical methods and how they impact the final outcome.</p> <p>It’s essential for patients to understand that their surgeon's expertise should guide the choice of technique. While patients may have preferences, the surgeon's recommendation is based on what will yield the best aesthetic results and ensure safety. Dr. Buonassisi encourages open communication, allowing patients to express their concerns while also educating them on the most effective surgical approach for their unique anatomy.</p> <h2>What Are Common Misconceptions About Scarring and Swelling?</h2> <p>One of the most common misconceptions regarding rhinoplasty is the belief that closed techniques result in less scarring and swelling compared to open techniques. Dr. Buonassisi clarifies that the amount of swelling post-surgery is comparable between both methods. The small scar from an open rhinoplasty typically becomes nearly invisible over time, making it a non-issue for most patients.</p> <p>Understanding the realities of scarring and swelling is crucial for setting realistic expectations. Patients should focus on the quality of the surgical outcome rather than solely on the visibility of scars. Dr. Buonassisi emphasizes that the priority should be on achieving a refined and natural-looking nose, which is often best accomplished through the open approach when necessary.</p> <h2>What If You Have Specific Nasal Concerns?</h2> <p>Patients with specific nasal concerns, such as a downward-tilting tip or asymmetrical cartilages, may feel inclined to request a closed rhinoplasty. However, Dr. Buonassisi warns that these issues often require more detailed adjustments that can be challenging to achieve with a closed technique. The open approach allows for greater precision and control over the surgical outcome.</p> <p>For patients who are adamant about a closed rhinoplasty despite the complexities of their case, Dr. Buonassisi is open to discussing their preferences. However, he stresses the importance of understanding that opting for a less effective technique could compromise the final result. Patients should be willing to consider the surgeon's recommendations based on their unique anatomical needs and desired outcomes.</p> <h2>How Can You Prepare for a Rhinoplasty Consultation?</h2> <p>Preparing for a rhinoplasty consultation involves more than just thinking about the desired changes to your nose. Dr. Buonassisi advises patients to come in with an open mind and a willingness to discuss their goals and concerns. It's essential to be ready to ask questions and seek clarification on any aspects of the procedure that may be unclear.</p> <p>Additionally, patients should be prepared to discuss their medical history and any previous surgeries or conditions that may affect their rhinoplasty. This information will help Dr. Buonassisi tailor his recommendations to suit individual needs. The more informed and engaged a patient is during the consultation, the better the chances of achieving a satisfying outcome.</p>

My name is Doctor. Bonesisi and I'm a board certified facial plastic surgeon with a practice in Vancouver, Canada. I've been specializing in cosmetic rhinoplasty for almost twenty years and I'm here to answer your questions about this very interesting procedure. Happy patients are educated patients, and that's why every question is a good one. So it's very common for patients to come and see me requesting very specific things, a very specific surgery or a very specific change to their nose, that they probably don't need or that isn't actually gonna look good on them. One of the common ones is that people will come and say, I I don't want an external rhinoplasty. First of all, I often find that patients don't really know what that is, that they've just read that, you know, external is, invasive, or it produces, you know, terrible scars or whatever. You know, and that that's just, you know, marketing. It's, you know, the difference between an external and an internal rhinoplasty in terms of the amount of scarring, the amount of swelling, is really minimal. So I think that the approach to the inside of the nose that's taken, for a particular patient really should be determined by what types of changes they need with their rhinoplasty. I don't think it's really all that helpful for a patient to say, I want a closed rhinoplasty versus I want a open rhinoplasty. It's like asking me to use a knife and not a pair of scissors when I'm cutting something. I think it's probably best for me to decide what technique is gonna be the safest and what's gonna be the most effective. So, you know, that's that's I hear that quite often. And once I've sort of explained the difference between the different surgical approaches, you know, people usually go with what I recommend. Like I said, some people are request or specifically want a closed or ionoplasty. They don't they don't usually understand what that is, but, you know, they've somehow they've, read or heard that it's better. You know, I think if somebody has a a tip abnormality, for for example, their tip is tilting downwards and it needs to be lifted up, as long as they have a straight septum, their their lateral cartilages are not particularly curved. If they really have a very simple straightforward, rotation of the tip required, sure, that can be done closed. That's very uncommon. Most people have asymmetric cartilages. They're often a little bit too wide. They need to be narrowed a little bit to make the nose look a bit more refined. These are all things that are very difficult to do with a closed approach, and often you compromise the result by, you know, trying to do it in closed because it's the patient's request. You know, I think it's it's always best for me to to recommend what's gonna give the best final result, and then if someone is willing to make a compromise and say, well, I don't mind maybe not getting as good a result because I really wanna use the closed approach for some reason. Well, you know, that's up to them, and that's something that I would certainly consider, but I think that's pretty uncommon. The mindset of patients when they're asking for a closed approach is that they are told or they've read that the scars are going to be much less if it's closed, that they'll have less swelling if it's closed, and that's not true. I think that the amount of swelling after an external rhinoplasty is no different than a closed rhinoplasty. The small little scar that is required with a skin incision for an open rhinoplasty will become invisible with time. I mean, it's not something that people notice. I find it hard to to see the scars in the postoperative period when I examine patients. It's really a non issue. The the the main reason to consider an external approach is if you have lots of very specific, very particular, very refined, maneuvers that need to be performed on the nasal tip. You know, you can do these much more, predictably with an open approach. So I I, you know, I mean, I don't often see a patient that is gonna get a better result with a closed approach, but if I do, then I will use that. So often patients will will will come in and say, look. I wanna have a rhinoplasty, but I don't want you to break my nose. You know, that I I could also do your surgery with one arm tied behind my back as well if you request that, but that's preventing me from achieving the results that most people really wanna have. If you have a big hump, you need to have osteotomies because you take the hump off, and you're gonna have a hollow, open roof in your nose, and your skin is gonna suck into there. That that would be a disaster. So unless you have a very, very small bump that can just very, very gently be shaved down, in a hundred percent of cases, you need to have osteotomies. Those nose bones need to be brought back together because the nose is hollow. If you take the hump down, there's a space there, and not only will your nose look very flat, but eventually the skin will grow down into the hole, and you'll have a big defect there. The osteotomies are definitely gonna cause bruising and swelling that you wouldn't have if you, if you didn't do them. But if you have a a hump on your nose that needs to be reduced, then, you you know, it has to be done. There's no way to to bring the nose bones back together appropriately without breaking the nose bones. So, again, you know, the term break is not particularly, elegant. Really, what we're doing is we're very precisely making cuts in the nose bones so that the nose bones can be moved to where they need to be to give you a good aesthetic result. And, yes, moving those nose bones does cause bruising, and it probably contributes to swelling, but that bruising and swelling is gone after eight to ten days. And I think if you you know, in the long run at the three three week mark, for example, you're you're not gonna have more bruising or swelling if you if you did the osteotomy, but you're gonna have a much, much nicer nose. And I think the goal is for your nose to be to look good for your whole life, not to come out of the surgery with no bruises. So the other worrisome request that I sometimes see is a patient who wants a very, very dramatic change to the shape of their nose. They may they may have a small hump, but they want or or even a large hump, wanna have vast majority of it taken away and have a very small nose. Or somebody wants their tip tilted dramatically upward to to a point that probably is beyond, you know, sort of aesthetic norms. That always worries me a little bit. I and I think in general, although they might think it's a good idea, it probably isn't. I think when you rearrange the nasal anatomy that much, chances are it's gonna cause some unusual aesthetic result in another part of the body. They may see their lip too much. Eyes may look too far apart if you narrow the nose too much. I think there's some some definite cosmetic risks with making dramatic changes to the nose, not to mention functional risks. If you're taking if you're making a nose extremely narrow or if you're taking a very large hump off, I think there can certainly be some some physiologic problems as a result of that. So if you're thinking about making changes to your nose, the most important thing is to have a quality consult with someone who does a lot of rhinoplasty, and you've got to do computer imaging so that you know what to expect from your result. Also, you need to be able to trust that the surgeon can predict what your nose is going look like with surgery. Thanks for listening, and check back regularly for new questions and my honest answers about rhinoplasty.

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