Closed or Endonasal Rhinoplasty

Hybrid Rhinoplasty™: the third pathway to nasal surgery

Rhinoplasty is the most challenging of all facial plastic operations, and remains the most desired cosmetic facial operation by patients on a global scale. This operation is undertaken for a combination of aesthetic and functional reasons. The structure, function, and aesthetic values of the nose are highly interlinked. Therefore, the astute rhinoplasty surgeon must consider these factors in unison. For example, the remodelling of key external features such as the tip and the aspect of the lower lateral cartilages can significantly alter the functions of airflow; and correcting internal problems such as a deviated septum may change the external appearance of the nose.
Technical advances in the past few decades have enabled surgeons to achieve results that used to be considered impossible. Specifically, in the field of endonasal surgery, also known as “closed rhinoplasty,” targeted, minimally invasive procedures greatly diminish the risks of serious complications. Combining “the best” of the two traditional approaches (open rhinoplasty and closed rhinoplasty), Dr. Pietro Palma has developed a procedure called Hybrid Rhinoplasty™ featuring unique properties of versatility and precision. Mastering rhinoplasty demands a long, and challenging learning curve that necessitates years of self-assessment, and professional development.
Rhinoplasty is the most customisable operation par excellence. No other procedure has the potential to alter the aesthetic, functional, and psychological impact on the patient to this degree. Every rhinoplasty must be tailor-made. This is a fundamentally important concept that Dr. Palma developed and trademarked as YOUnique Rhinoplasty™. Dr. Palma has dedicated his entire professional activity to this mission. He is available at Clinica del Viso and at Casa di Cura La Madonnina, both in Milan, for preliminary interviews with patients who are considering the possibility of undergoing nose surgery.

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The two traditional surgical accesses: open rhinoplasty and closed rhinoplasty

Nasal plastic surgery involves a myriad of techniques that can be divided into two main fields, distinguished by their main access points. In the open procedure (or external rhinoplasty), the surgeon cuts the columella and lifts the flap of skin and soft tissues, exposing the boney-cartilaginous framework. In the closed procedure (or endonasal rhinoplasty), the surgeon hides the points within the nose based on the particular defect that requires correction.
All other factors being equal, the final results and post-operative recovery times are quite similar when comparing the two basic approaches to rhinoplasty. In the closed approach, less experience surgeons may struggle to achieve the patient’s aims due to the reduced visibility of the cartilaginous skeleton. This could be considered a drawback of the closed procedure.

The third pathway for rhinoplasty: the advantages of combining and endonasal and open technique in an exclusive hybrid procedure

In the “third way” identified by Dr. Palma, the surgeon can enjoy an optimal view despite the internal incisions. The hybrid approach has already been described in medical literature («Hybrid rhinoplasty: The 21th-Century approach to remodeling the nose», Archives of Facial Plastic Surgery, 2010). Hybrid Rhinoplasty™ combines the advantages of the two procedures that had hitherto been considered incompatible . More versatile than traditional closed rhinoplasty, and adjustable according to the objectives and anatomy of the individual patient, hybrid rhinoplasty does not involve the risk of scars on the columella.
In hybrid rhinoplasty, the internal incisions vary in number and position based on the specific requirements of the patient. The versatility of Dr. Palma’s approach stems from accurate and focused manoeuvres, fine-tuned based on the individual anatomy, and aesthetic-functional goals. Advantages of Hybrid Rhinoplasty™ include the same precision as open rhinoplasty plus the mini-invasiveness of closed rhinoplasty, quick recovery times, and no visible scar on the columella.

Closed rhinoplasty with Dr. Pietro Palma in the Milan clinics

Considering the highly demanding aesthetic and functional results, in addition to the psychological impact on the patient, becoming a rhinoplasty surgeon requires years of professional development and cannot be one of the many voices in a surgeon’s repertoire. For this reason, Dr. Palma Dr. Palma has dedicated his academic and professional activity solely to nasal surgery (corrective, functional and plastic-aesthetic). His perseverance, exclusive commitment, and development of techniques over the past 25 years have brought him international recognition, and ultimately led to the development of YOUnique Rhinoplasty™.
Rhinoplasty demands a thorough and exhaustive pre-operative diagnostic pathway that ultimately paves the way for designing and performing a tailored nasal operation, called YOUnique Rhinoplasty™. For non-binding consultations, Dr Palma receives his patients at the Clinica del Viso (Piazza Repubblica, 21 – Milan, Italy info@pietropalma.it ) and at the Casa di Cura La Madonnina (Via Quadronno, 29/31 – Milan, Italy cup.cclm@grupposandonato.it). Dr. Palma does not accept requests for surgery based exclusively on photos sent via the Internet.


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