Closed Rhinoplasty Technique: Best Approach to Nose Surgery Says Beverly Hills Plastic Surgeon Dr. John Diaz

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Dr. John Diaz, an extensively trained Beverly Hills plastic surgeon, says the “closed” rhinoplasty approach is the best way to perform nose surgery. Most surgeons favor the “open” technique, but according to Dr. Diaz, it creates additional scarring and is more invasive.

Beverly Hills Plastic Surgeon Dr. John Diaz
Once I began my private practice, I noticed that a lot of people were self-conscious about the scarring from open rhinoplasty

Dr. John Diaz, a Beverly Hills plastic and reconstructive surgeon, asserts his belief that closed (endonasal) rhinoplasty is more beneficial for the patient than open (external) rhinoplasty, both physically and emotionally.

The type of rhinoplasty technique used is dependent on two factors: the complexity of the case and the ability and expertise of the surgeon. Many surgeons perform rhinoplasty through the open method due to the fact that it provides great visibility and access; during the open rhinoplasty procedure, the surgeon makes a small incision across the middle of the columella (the tissue in between the nostrils which runs from the tip of the nose down to the lip). The skin is then pulled back, exposing the structures of the nose.

According to Dr. Diaz, this approach is more of an advantage for the surgeon than it is for the patients: “It offers a greater ease of operation, but patients still want less scarring.” Although many medical professionals may say that the scar left behind on the columella is relatively minor, Dr. Diaz says that the scar is usually visible and is “a daily reminder” for the patient that they underwent surgery. Just because he or she underwent plastic surgery doesn’t mean that he/she should have to see the scar every day. “We have to listen to our patients,” he says, acknowledging that he frequently meets with individuals who desire beautiful nose surgery results with a scarless outcome. “Once I began my private practice, I noticed that a lot of people were self-conscious about the scarring from open rhinoplasty,” he admits. Hearing the complaints from patients who received open rhinoplasty from other surgeons motivated Dr. Diaz to gain additional training to perfect the closed approach.

“The closed approach is not being taught, so the skills are being lost,” he says, emphasizing that surgeons should be doing everything possible to provide patients with less scarring. Closed rhinoplasty involves incisions made only in the interior of the nose, which are never visible. According to Dr. Diaz, if the surgeon is properly trained in this approach, he or she can provide beautiful, natural-looking results.

In addition to visible scarring, the open approach allows the potential for dramatic and, sometimes, overzealous changes, says Dr. Diaz. Because the cartilage is completely exposed in an open approach, it allows for more manipulation and structural changes than in a closed approach. Although this is desirable in some cases, it can easily lead to an overdone and unnatural looking result. He frequently sees patients who need major revisions after an open rhinoplasty for these reasons. Dr. Diaz feels that the closed approach, on the other hand, encourages a more natural look because “It helps prevent the surgeon from making severe changes to the structure of the nose. “This is important,” he says, “Because once you make a severe change, the patient may be past the point of no return.”

Dr. Diaz has been in private practice for six years. He is a diplomate of the American Board of Plastic Surgery (ABPS) and is a Fellow of the American College of Surgeons (F.A.C.S.). Dr. Diaz is a member of the American Society of Plastic Surgeons (ASPS), California Society of Plastic Surgeons (CSPS), and the Los Angeles Society of Plastic Surgeons (LASPS). He is a published author and has been a featured expert in numerous magazines and television outlets, including CNN, NBC, E! Network, and Telemundo.


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