Every year, open rhinoplasty has gotten more complicated, with more steps, wider dissections and disruption of normal nasal architecture, and more complex suture and grafting techniques.  The upshot of all of that dissection is more postoperative swelling and even skin loss from poor circulation.

What is important to note in all of these procedure changes is that none of them corrected problems that the patients originally had.  This year’s revisions only corrected problems that last year’s procedure had made.

The surgery was too just extensive and destructive.

When you stop looking at adverse information but continue doing what you are doing, surgery stops being science and becomes religion.  That is not the way it should be.  We must constantly reevaluate our procedures and make advances for patients.  When surgeons show 5 year postoperative results, they are not showing their current methods because they keep adjusting them.

I have used the same techniques for more than 30 years because they work every time if I judge the tissues properly and if healing is what I expect.  All are anatomical; none involve struts or internal sutures.  That is why my long-term follow-ups show real results.

The endonasal approach is directed only to areas that the patients don’t like — bridge height, tip shape, nasal length, poor airways.  No other parts are invaded, so the chance of creating brand-new problems is much lower and the recovery is much faster.

The other great advantage is that the surgeon can assess surface shape and proportion accurately through closed rhinoplasty.  That is just impossible when the skin has been pulled away from the skeleton.

Almost every other plastic surgery procedure – facelift, forehead lift, breast augmentation, eyelid surgery, abdominoplasty – is becoming more limited and safer – every one except rhinoplasty, which is going exactly the opposite way – more aggressive, more grafting, and more chance to create new problems.

For me, it is a simple choice.