Open rhinoplasty

Pietro Palma: tra i massimi esperti di rinoplastica al mondo

Rhinoplasty (the surgical procedure that changes the shape of the external nose) and septorhinoplasty (the combined intervention on both the external and internal nose) are aimed at remodeling of the nose. This goal can be achieved via different techniques. Surgical literature traditionally subdivides rhinoplasty into external rhinoplasty (also “open rhinoplasty”), and endonasal rhinoplasty (or “closed rhinoplasty”).
Dr. Pietro Palma is among the leading experts in rhinoplasty both in Italy and on an international level. For over 20 years, he has been dedicating his activity entirely to rhinoplasty and septorhinoplasty. Dr Palma believes that absolute dedication is required to master this complex and fundamentally important operation and considers rhinoplasty as his sole professional mission.

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Open rhinoplasty or closed rhinoplasty? Pros and cons of the two techniques

In nasal surgery, we conventionally distinguish two main operating modes – external or “open” rhinoplasty, and endonasal or “closed” rhinoplasty.
In external rhinoplasty, the surgeon cuts the columella (the “pillar” between the nostrils), and then lifts a flap of skin and soft tissues: this offers an opencast view of the nasal cartilages and bones. The first advantage over “closed” rhinoplasty is blatantly obvious: the surgical access via external incision allows a full and direct view of the internal skeleton. The optimal line of sight is the main reason behind the success of the open variant, even among less experienced operators. However, the technique is not free from drawbacks, such as generally longer operating and healing times, prolonged permanence of soft tissue swelling, and greater rigidity of the external nose. Open rhinoplasty also presents the possibility – albeit remote when relying on experienced operators – of leaving a visible scar on the columella, which entails the risk of making the operation permanently visible.
In contrast, in endonasal or closed rhinoplasty, all entry incisions are made inside the nose. The first benefit is the absence of external scars, which also implies faster healing times and reduced swelling. On the other hand, the disadvantages include more complicated surgical manoeuvres and possible lower precision for less experienced operators. Closed rhinoplasty is preferred especially when the goal is bone and cartilage reduction, though it may be inadequate in critically important operations and complex revisions. In the reconstruction of nasal septum and tip, as well as in secondary rhinoplasty, the external access is not just preferable, but often unavoidable.

The “hybrid” procedure conceived by Dr. Palma: all the pros of open and closed rhinoplasty in a single method

For more than a decade now, Dr. Palma has been working with a “hybrid procedure” that combines the advantages of two methods, hitherto considered mutually exclusive. We can define hybrid rhinoplasty based on a scientific article in the journal Archives of Facial Plastic Surgery (published 2010), as a versatile endonasal rhinoplasty, customisable from the incision site.
In classical closed rhinoplasty, the incisions are typically at the level of the nostrils. In the hybrid procedure instead, surgical access can be altered according to the objectives of the operation.
Hybrid rhinoplasty allows the same operational precision as the opencast procedure without any visible scar. Furthermore, the “third way” reduces healing times, invasiveness, and risk of revisions (of about 30%).The experienced surgeon can always consider the endonasal hybrid surgery for revisions, as well as for extensive reconstructions of the septum and tip.

Open rhinoplasty with Dr. Pietro Palma in the Milan clinics

With over 25 years of surgical practice exclusively dedicated to the nose, Dr. Pietro Palma is one of the preeminent rhinoplasty and septoplasty specialists in Italy and abroad. Nasal surgery is among the most challenging and critical operations for its aesthetic, functional and psychological impact on the patient: to master all the subtleties and entanglements of the procedure, the facial surgeon must experience a professional path where research, application, and improvement of techniques constantly evolve.
Among the most requested surgical treatments – and by far the most requested in facial surgery -, rhinoplasty cannot be one of the many items that make up a surgeon’s repertoire. Dr. Palma has devoted his intense academic and professional activity solely to nasal surgery, intended as corrective, functional, and plastic-aesthetic. Alongside years of practice with patients from all over Italy and from abroad, Dr. Palma has matured a unique approach where the preparatory phase is as relevant as the actual surgery.
Simple, complex, and extreme nasal problems all undergo a thorough and complete preoperative diagnosis, which allows Dr. Palma to design and perform a tailored nose surgery called YOUnique Rhinoplasty™. For more information, or to request an interview with Dr. Palma, contact the Clinica del Viso (Piazza Repubblica, 21 – Milan, Italy at the Casa di Cura La Madonnina (Via Quadronno, 29/31 – Milan, Italy The rhinoplasty surgeon does not operate solely based on photos sent via the Internet. On occasion, Dr. Palma may discourage the patient from seeking a surgical option.