Open vs Closed Rhinoplasty Surgery

Rhinoplasty can be performed under a general anesthetic, sedation, or with local anesthetic. Initially, local anesthesia, which is a mixture of lidocaine and epinephrine, is injected to numb the area and temporarily reduce vascularity.

There are two possible approaches to the nose: closed approach and open approach. In closed rhinoplasty, incisions are made inside the nostrils. In open rhinoplasty, an additional inconspicuous incision is made across the columella (the bit of skin that separates the nostrils).

The surgeon first separates the skin and soft tissues of the nose from the underlying structures. The cartilage and bone is reshaped, and the incisions are sutured closed. Some surgeons use a stent or packing inside the nose, followed by tape or stent on the outside. In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone, as a graft, to strengthen or change the shape of the nose.

Usually the cartilage is harvested from the septum. If there isn't enough septum cartilage, which can occur in revision rhinoplasty, cartilage can be harvested from the concha of the ear or the ribs. In the rare case where bone is required, it is harvested from the cranium, the hip, or the ribs. Sometimes a synthetic implant may be used to augment the bridge of the nose.

Rhinoplasty Surgery

Reconstructive nose surgery was first developed by Sushruta, an important Ayurvedic physician in ancient India, who is often regarded as the "father of plastic surgery." Sushruta first described nasal reconstruction in his text Sushruta Samhita circa 500 BC. He and his later students and disciples used rhinoplasty to reconstruct noses that were amputated as a punishment for crimes. The techniques of forehead flap rhinoplasty he developed are practiced almost unchanged to this day. This knowledge of plastic surgery existed in India up to the late 18th century as can be seen from the reports published in Gentleman's Magazine (October, 1794).
Patient, three days post-op. Procedures included dorsal bone reduction and re-setting and refinement of nasal tip cartilage. The typical orbital discoloration is also present due to trauma and disruption of blood vessels around the eyes. Also present is a splint.

The precursors to the modern rhinoplasty surgeons include Johann Dieffenbach (1792-1847) and Jacques Joseph (1865-1934), who used external incisions for nose reduction surgery. John Orlando Roe (1848-1915) is credited with performing the first intranasal rhinoplasty in the U.S. in 1887.

Prior to the 1970’s, all rhinoplasty surgeries were performed via the intranasal approach, which is often called closed rhinoplasty. However, in 1973, Dr. Wilfred S. Goodman published an article entitled “External Approach to Rhinoplasty”[1] which helped initiate a shift in rhinoplasty techniques to what has become known as the open rhinoplasty. The open rhinoplasty technique was further refined and popularized by Dr. Jack Anderson in his article “Open rhinoplasty: an assessment”[2]. The open approach to rhinoplasty gained in popularity during that time, but it was used mainly for first-time rhinoplasty surgery and not for revision rhinoplasty.

In 1987 Dr. Jack P. Gunter, who trained under Dr. Anderson, published an article[3] describing the merits of the open rhinoplasty approach for secondary rhinoplasty. This was a major shift in the approach to treating nasal deformities that arose from a previous rhinoplasty.

Non Surgical Nose Jobs? Alternative to Deviated Septum Surgery

Considering a surgery on your nose? Be it a deviated septum surgery, or rhinoplasty, there may be a solution to keep you from going under the knife. There are non-surgical nose job alternatives. These surgeries are a new and exciting alternative available to patients interested in improving the shape of their nose without undergoing invasive deviated septum surgery. The benefits of nose jobs without surgery are faster results, quicker healing time, and little or no pain.

Patients who are interested in nose surgery may be surprised to find out they are actually candidates for a non surgical nose job. This popular new treatment is an excellent alternative to the traditional rhinoplasty or deviate septum procedure.

A nose job without surgery involves using injectables such as BOTOX® Cosmetic, Restylane®, or Radiesse® to shape and contour the nose. Unlike a deviated septum procedure, these fillers allow patients to obtain quick results with little or no healing time.

A nose job without surgery is an excellent option for patients who want a non-invasive, non-surgical procedure and who are looking for fast, satisfying results.

Most nose job patients visit a surgeon to get rid of bumps and bulges on their nose or to repair a deviated septum. When nasal imbalance is minor, a nose job without surgery can provide patients with outstanding results and an improved overall appearance.

Unfortunately, those with major nasal deformities, deviated septums, and those who are looking to reduce the size of their nose are not candidates for the 15 minute non-surgical nose job. For these patients, surgical intervention is necessary..

The 15 minute non-surgical nose job is relatively painless and can be completed in one short office visit. During the treatment, a surgeon will inject the facial filler into the desired areas of the nose to help camouflage abnormalities. Though some patients may be concerned that the nose will look larger after treatment, not to worry - the treatment simply smoothes out the nose so it appears as one straight line.

A nose job without surgery is an excellent and affordable option for patients who would like to achieve a more pleasing appearance without undergoing extensive rhinoplasty or deviated septum surgery

Hollywood and Deviated Septum Surgery

Hollywood is full of actors and actresses that have gone under the knife to have deviated septum surgery or some related nose surgery. It is almost as common to have a nose job as it is to have a physical. There are many that have done it for the sake of looks and there are those that have needed them because of health reasons. What ever the reason the jury is out on whether or not it has helped or hurt their career.

The list of Hollywood stars that have gone under the knife for one reason or another is obviously many. If one was trying to find a statistic of how many have had some surgery or another, the statistic that would stand out more is who hasn’t gone under the knife for deviated septum surgery and other surgeries, than those that have.

Some of the most notable actresses that have had deviated septum surgery include Jennifer Aniston, and Cameron Diaz. Again whether it was necessary or whether it affected their looks the jury is still out. Either way so far it doesn’t appear that their careers have suffered as a result.


The one actress whose career suffered as a result of nose surgery was Jennifer Grey. Many will remember her from her most notable movies being Dirty Dancing, and Red Dawn. After her role in the film Dirty Dancing, Grey decided to have a nose job to remove the bump from her nose.


It is true that the bridge of her nose, had a bump on it, and it was well noticed, but that nose was who she was, and it was a part of her. It was so much a part of her that even some friends didn’t really recognize her once she recovered from her surgery.





There are plenty enough pictures and “Access Hollywood” type interviews out there to see that the results of her surgery have almost literally changed her look to be another person all together


In an interview after her surgery she stated that the surgery on her nose was the “worst mistake she had ever made”. She stated that she didn’t look like the girl from dirty dancing, just someone who somewhat resembled that girl.


There are some more recent starlets that have received similar comments since going under the knife for deviate septum surgery and other operations. A phrase has come out nicknamed the "Jennifer Grey" syndrome, which has been attached to celebrities such as Ashlee Simpson and Ashley Tisdale from "High School Musical.

FAQ's on Deviated Septum Surgery

What is a deviated septum?

-A deviated septum is when that bone and cartilage of the nose is no longer straight.

How do you get a deviated septum?

-There are numerous ways that a deviated septum can take place. First off a person can actually be born with the condition called congenital. A broken nose can create the deviation. Even old age with normal wear and tear can cause the septum to go crooked.

How much does deviated septum surgery cost?

-Depending on the doctor and the extent of the work that needs to be done, deviated septum surgery can cost between $1500 to $6000.

What is the recovery time after surgery?

-Unless there are complications, deviated septum surgery can be taken care of in the same day and usually take place in an outpatient surgical center. The surgery itself is usually only 1 ½ hours long

What do you need to do to prepare for the Deviated Septum Surgery?

-Two weeks prior to surgery, you will need to stop taking aspirin and other medications that can increase your risk of bleeding. You should have nothing to eat or drink after midnight on the night before your surgery. If your procedure is to be done on an outpatient basis, you will need someone to drive you home and stay with you the first 24 hours.

Does insurance cover Deviated Septum Surgery?

-Insurance coverage will depend on two factors: the reason its being done, and your insurance carrier. It's important to call your insurance carrier and find out the details of your particular plan.

Are there any risks associated?

-There are a number of risks associated with this surgery. Risks can range from a little as nose bleeding for a few days after surgery to a collapsed septum. In some cases a perforated septum or hole in the septum resulting in whistling sounds when breathing. The biggest risk is cerebrospinal fluid leak.

What are the benefits to this surgery?

-From a cosmetic perspective, this surgery can potentially make your nose look better. Depending on the severity of the deviation, it can create breathing problems, and is considered part of the reason for sleep apnea.

The Pro's and Con's of Deviated Septum Surgery

Pro’s:

· Breath more freely and less sinus infections.

· Can help in the removal or lessening of effects of sleep apnea

· Improvements to your nose's appearance such as: increasing or decreasing its size, making it wider or narrower, removing bumps, changing its contour, and changing the size or shape of your nostrils

· If you have a deviated septum, surgery known as septoplasty can correct the problem. Some people have blocked or malformed nasal passages which make it difficult to breathe properly.

· The surgery is minimally invasive and you can usually go home the same day.

Con's:

· If too much tissue is removed, you could have a collapsed septum, making the nose look deformed

· A perforated septum, a hole in the septum that whistles when you breathe and can cause bleeding

· As with any surgery, there is always a risk of infection. This infection will be treated with an antibiotic

· You may experience numbness of the nose, cheeks, and upper lip. Numbness in the tip of the nose may take several months to return to normal. Other areas will resolve more quickly.

· One of the extremely rare but serious complications of deviated septum surgery is cerebrospinal fluid leak. Cerebrospinal fluid is the fluid that travels through the ventricals of the brain Nasal obstruction due to failure to straighten the septum or later re-deviation of the septum, or the re- growth or swelling of the turbinates.

Deviate Septum Surgery - What and Why?

Why deviated septum surgery? Before this question can be answered effectively, a brief introduction into what a deviated septum is needs to be examined.

The nasal septum is the area of the nose that separates the nasal passages. The septum is made up of both bone and cartilage.

A deviated septum is when that bone and cartilage of the nose is no longer straight. There are a few ways that a septum may deviate, one way is at birth. This type of deviation is called congenital.

A more common way is by injury, caused by a broken nose. Even old age can create bending from one side or the other. However the deviation happens it can cause breathing problems and even more serious affects such as sleep apnea.

The technical name for deviated septum surgery is called Septoplasty. Other common terms for this surgery are submucous resection, or septal reconstruction. This surgery along with other procedures can be used to treat sinusitis, or the infection or inflammation of the lining of the sinus cavities, and sleep apnea.

A visit to the doctors office will determine whether deviated septum surgery is necessary. The doctor will start out by using an endoscope, a thin lighted instrument, to view your nasal passages and the shape your septum. The surgery typically takes between 1 to 1 ½ hours, usually under local or general anesthesia. In most cases this is an outpatient surgery.

The septum and the entire nasal passage is covered over with a soft tissue layer, known as the nasal mucosa. This mucosa has to be separated from the underlying cartilage and bone. The doctor will enter in through the nostrils and make small incisions to the mucosa and bone. The doctor will then trim and clean up the bent cartilage, and replace the mucosa over the exposed bone and cartilage.

Deviated septum surgery or Septoplasty is not for everyone. Seeing a doctor to determine your condition can help determine if the surgery for your deviated septum is necessary.