To create that desired naturally balanced appearance, Dr. Binder generally performs the entire rhinoplasty procedure from the inside of the nose (closed rhinoplasty technique), so there are no visible signs of scarring. The closed technique is performed without making an incision across the columella (the delicate island of tissue between the nostrils). Incisions in this operation are made inside the nostril (endonasal), where they will be completely invisible after healing.
Many new surgeons use the open technique to access the nasal skeleton for easy viewing. It is generally considered a simpler technique that requires a shorter learning curve for the surgeon which may explain why many medical schools today only teach the open approach. Partly because of his many years revising or correcting primary rhinoplasty procedures, Dr. Binder has found that the open technique has some potential drawbacks. In addition to the possibility of causing significant scarring on the outside of the nose, the open technique also has an increased potential for skin shrinkage, longer duration of swelling and is generally more unpredictable than the closed structure technique. Also, sometimes the nose simply can’t be "opened" for the 3rd or 4th time without an increased risk of complications. A growing group of patients that have had several open nasal procedures present a new and formidable challenge to the revision rhinoplasty specialist. In these situations, only a few surgeons have the ability to apply the revision closed structure rhinoplasty techniques to effectively treat the problem.
Dr. Binder will use the open technique in special cases such as when total tip (lobular) reconstruction is necessary in complex revision rhinoplasty cases or in patients with a history of cleft lip disorder. For these special cases, Dr. Binder strongly believes that the revision rhinoplasty specialist must have the ability and expertise to perform both open and closed rhinoplasty.
Dr. Binder believes the closed rhinoplasty technique produces more stable and predictable results in both primary and revision rhinoplasties. In experienced hands, it offers great latitude and flexibility to allow a plethora of reshaping possibilities. Bone and cartilage can be removed or, in some cases, taken from another part of the patient’s body and added in for better shape or support.