Objectives: To share our experience with open structure rhinoplasty and to evaluate its aesthetic results subjectively as well as objectively
Study design: Quasi experimental study
Place and duration of study: This study was conducted at Department of Otorhinolaryngology and Head & Neck Surgery, Islamic International Medical College Trust Hospital, Rawalpindi from October 2007 to October 2009.
Materials and Methods: A total of 31 patients underwent open structure rhinoplasty with or without septoplasty under general anesthesia. Patients were followed up for a minimum period of 8 months. Cosmetic results of rhinoplasty were evaluated subjectively and objectively both by the patient and the surgeon considering pre and postoperative standard photographs. Cosmetics results were categorized as appreciably good, fair or worse according to the surgeon’s evaluation and patient’s point of view.
Results: Out of 31 patients, 23 (74%) were male and 8 (26%) were female. The age range was 14 to 45 years. Open structure rhinoplasty combined with septoplasty was performed in 21 (68%) patients whereas 10 (32%) patients had only rhinoplasty. Autologous cartilage grafts were used in 22 (71%) patients. Among them nasal septal cartilage was the commonest donor site used in 19 (86.3%) patients. The postoperative period was uneventful, painless and without postoperative bleeding in all the patients. Cosmetic results were shown to be appreciable good in 24 (77.4%) patients by objective evaluation and in 20 (64.5%) by subjective evaluation. Improvement in nasal airway after septorhinoplasty was noted in 17 (81%) patients.
Conclusion: Open structure rhinoplasty provides excellent exposure of osteocartilagenous nasal framework providing the opportunity to perform wide variety of modern rhinoplasty techniques resulting in superb aesthetic results both subjectively as well as objectively.
Key words: Rhinoplasty, open approach, Aesthetic surgery

Introduction

Open structure rhinoplasty was popularized by Goodman and Charles in the 1970s when they introduced the modified transcolumellar incision, make which excellent exposure of nasal osteocartilagenous framework was made possible.¹ This approach has becomes increasingly popular during the last decade and now considered a firmly established and important technique in rhinoplasty surgery.²
Open structure rhinoplasty has numerous advantages. It provides an unobstructed view of nasal cartilaginous and bony framework thus enhancing the ability to access and manage structural deformities by direct inspection. This aspect is especially beneficial in teaching rhinoplasty to the junior surgeons, which is considered to be one of the most difficult of plastic surgical procedure. However, open rhinoplasty has some disadvantages especially increased operative time, more profound scar contracture, prolonged postoperative swelling, visibility of columellar scar and loss of nasal tip support if compensatory measures are not adopted during the procedure.³
The purpose of the present study is to share our experience with this technique and to access the aesthetic results of it from both surgeon’s and patient’s point of view.

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