Although general plastic surgeons are more than capable of performing rhinoplasty under most circumstances, they may not always be the best choice depending on the desired outcome – especially as it relates to functional rhinoplasty.
Rhinoplasties are typically performed by either a general plastic surgeon or an otolaryngologist with training in facial plastic surgery. Jeffrey J. Lehman, M.D., F.A.C.S., a board certified otolaryngologist at The Ear, Nose, Throat and Plastic Surgery Associates, is one such otolaryngologist with years of education, training and subsequent experience in facial plastic surgery with a concentration on rhinoplasty.
“The general plastic surgeon usually goes through a general surgery training, though not always, and then does the plastic surgery fellowship afterwards, which involves all aspects of plastic surgery,” Dr. Lehman explains.
He says ENT surgeons are well positioned to perform rhinoplasties given the extensive training they receive in nasal procedures. Many plastic surgeons undergo training to perform all aspects of plastic surgery throughout the body, meaning they are less focused on just rhinoplasties. By contrast, ENTs with a focus on facial plastic surgery just focus on the face; and, therefore, have more rhinoplasty experience and more successful cases under their belt than traditional plastic surgeons in some instances.
Surgical Approaches to Rhinoplasty
According to Dr. Lehman, there are two main approaches to surgical rhinoplasty – the closed approach (endonasal) and the open approach (external).
All surgical incisions made for the endonasal approach are made inside of the nostrils. The parallel incisions encircle about half of the nostril lining, but no part of the incision can be seen externally and there is no visible scar. Although not having a visible scar can be a major benefit, there are considerable challenges and technical limitations associated with this approach.
With the closed approach, the “healing, swelling and the changes in the nose occur over a period of about six months,” explains Dr. Lehman.
An ENT makes a small bridging incision, called a trans-columellar incision, to adjoin the right and left nostril incisions. The nasal skin can be folded upward and provide open visibility of the lower nasal structure. The open rhinoplasty approach allows for minimal distortion of the nasal cartilage and most individual components of the nasal skeleton can remain undisturbed.
An external rhinoplasty may involve external scarring, but the approach may be more accurate, versatile and effective because the surgeon has complete visibility while reshaping the nose.