Some of the most common techniques applied in the open structure rhinoplasty are cartilage grafting harvested from nasal septum, ear's concha bowl or rib cartilage, harvesting of deep or superficial temporalis fascia grafting, tip domal plication or suturing, plasties of tip domes, alternate incomplete domal transections, tip graft, Sheen's graft, shield graft, columellar strut or tutor graft, lateral cruras tutor or batten graft, lateral cruras exchange or crossed location, lateral cruras replacement graft, lateral cruras caudal extension graft, tongue in groove fixation of medial cruras, lateral and medial cruras plication or suturing, lateral and medial cruras length trimming for shortening or grafting for lengthening, lateral and medial cruras repositioning, medial cruras footplates plication or suturing, nostrils rim graft, middle vault spreader or spacer grafts, paramedian reduction of dorsal plateau or rhombus, septal lengthening graft, septal caudal extension grafts, dorsal onlay graft, supratip graft, radix graft, dorsal fascia graft and other custom grafting, alar base reduction, nostrils reduction and other custom procedures.
Typical scenarios where an open structure rhinoplasty is indicated are the short nose, long nose, poorly defined tip, short or underprojected tip, overprojected tip or Pinocchio's nose, bifid or cleft tip and columella, bulbous tip, boxy tip, asymmetric tip, buckled tip, inverted or concave lateral cruras, over rotated or upturned tip, piggy nose, severely hooked or droopy tip, hanging columella or columellar exposure show, alar rim retraction, septal mucosa exposure show, sunken supratip, polly beak deformity or supratip prominence, tension nose, pinched middle vault, hourglass dorsum, rhomboid dorsum, broad dorsum, humpless dorsum, dorsal ridges, low sunken dorsum or saddle nose deformity, low radix, high humpless dorsum, high radix, prominent alar flare, large nostrils, filmy and transparent nasal skin, pinched or incompetent nasal valve, severe asymmetries and others; as a rule of thumb any augmentation, lengthening, aggressively downsizing, aggressively shortening, significantly reshaping, congenital, atypical and complex rhinoplasty belongs to this modality, as well as those cases the patient is seeking high grade of refinement and perfecting.
This nose job is normally carried out by means of the open rhinoplasty or external approach at the columella and also inside the nostrils, alar base and others, with optimal quality and well concealed scars, through which structure of the nose is modified as well as resized, grafting applied, plications or sutures performed and other maneuvers executed; additional well hidden scars behind the ear, within the hairy temple scalp, underneath the breast and others might be necessary as donor sites of any grafted material.
Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed and open approach structure and non structure rhinoplasties should execute high end rhinoplasty cases, should they feel capable and comfortable with the challenge.
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