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Closed Rhinoplasty

The goal of the Closed Rhinoplasty approach is to achieve a more prominent nasal bridge and tip shape, fitting a piece of shaped silicone underneath the skin layer. The degree of curvature and prominence will depend on how elastic the individual’s nose skin is. Fitting an overly large silicone piece will create potential issues down the road, including crooked bridge shape, see-through skin making the silicone underneath visible, implant protrusion, etc.


Nowadays, there are several techniques used for achieving a more prominent nasal tip. These may be taken from elsewhere in the body, including conchal cartilage, coccyx tissue, or tummy tissue and applying them to the apex of the silicone to thicken/strengthen the nose tip to withstand the extra tension.

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For individuals with mild bumpy bridges or humps, the surgeon may consider filing down the hump to taste. Individuals with wide nasal bridges who want to achieve a more slender shape, the surgeon may consider including osteotomy as part of the operation.


For individuals with fillers, the surgeon will consider whether to perform a closed or opened rhinoplasty.

Recommended for:

  • Individuals who want a more prominent nasal bridge

  • Humps (mild)

  • Wide nasal bridge

 

Operation details:

Before the operation, the surgeon will prepare and shape the silicone piece, using the patient’s nasal bridge as the reference. If deemed necessary, the surgeon will take the needed conchal cartilage or coccyx tissue first before beginning closed rhinoplasty. He  will cut open the right nostril, create space for the silicone piece, stop the bleeding, and then insert the silicone before sealing the wound. If osteotomy is performed, there will be a 2mm-long near the inner canthus on both sides.

 

Post-operational treatments:

  1. Apply cold pack to the area during the first 3 days.

  2. Wrap nose bandage for 3 days.

  3. Clean the area daily, avoid contact with water.

  4. Internal cuts inside the nose do not need suture removal. Nose can come in contact with water only after 7 days (suture will remove itself after 1-2 months).

  5. Suture removal for osteotomy wound after 1 week, for conchal cartilage and coccyx tissue after 2 weeks. The wound can only get in contact with water after suture removal.

  6. Avoid nose picking or blowing.

  7. Sleep with head straight and avoid wearing eyeglasses for 1 month

  8. Bruises will typically be less noticeable after 2-3 weeks, and swelling after 3-6 months.

 

Possible Side-effects:

  • Overly prominent nasal bridge, resulting in an unnatural facial appearance. The inserted silicone piece may be visible.

  • Deviated nose, resulting from the silicone piece used being too small relative to the space, allowing the silicone to shift around. The patient can adjust the silicone position by his/herself, or consult with the surgeon in case of any difficulty.

  • Using an overly large silicone piece can lead to the silicone protruding out from the apex or bridge. The skin will become thin, and if left untreated, will lead to protrusion. The main parts risking protrusion include the nasal bridge, apex, and inside the nostril. It is recommended to consult with the surgeon as soon as possible.

  • Hypertrophic scar inside the nose. Although a rare case, it can be treated by injecting steroids around the wound area.

  • Uneven nostril. This may be caused by the nose cartilage shifting position during the operation, sloppy wound closure job, scar tissue contracting, etc. It is recommended to consult with the surgeon for a possible corrective surgery.

 

How long will the change last?

The change will typically last a lifetime as long as there is no severe concussion.

 

However, the individual may experience capsular contracture after several years, making the silicone edge visible and/or calcified capsule, resulting in irregularity. This can also happen with elderly people with relatively thin skin.

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