Scarless Rhinoplasty in NYC

In addition, the columella (skin bridge between the nostrils) tends to appear as though it is hanging too low.  And on the frontal view of the nose,  the area just below the tip of the nose called the infratip lobule often tends to still be prominent and drooping. The most common explanation for this is that surgeons who use the closed approach all too often do not address the lower third (tip, infratip lobule , ala, columella) relationships at all.  They simply remove the hump on the nose and leave the rest of the nose untouched. The reason for this is because it is incredibly technically challenging to address the relationship of these structures (of the lower third of the nose) using a closed approach, so they are neglected all together, making the operation  easier and faster for the surgeon. Even when the open approach is utilized  and complete access to the lower lateral cartilages of the nose (which are responsible for creating the outer appearance of the tip, infratip lobule, ala and columella)  is obtained, it is difficult for many surgeons to master a technique that will deliver ideal tip aesthetics at the end of the procedure. So doing this through a closed approach presents an even greater challenge for the surgeon. 

As mentioned previously, many surgeons have switched from a closed approach to an open approach in order to improve aesthetic outcomes, particularly with the lower third of the nose, but still they fall short. Given that rhinoplasty is Dr. Cangello’s passion, he sought to learn from surgeons who are the true masters of rhinoplasty, located throughout Turkey and Europe. They perform rhinoplasty on a different level as compared to most of the surgeons in the United States with aesthetic results that are second to none and they are able to achieve these results through a closed approach. . These masters have passed on their techniques and knowledge to Dr. Cangello, and as such, he is able to create the most aesthetically (and functionally) ideal outcomes through a very minimally invasive, limited incision approach. It takes a very long time to master these techniques, but the results of doing so are: ideal tip and lower third of the nose aesthetics, much shorter recovery period, minimal swelling and usually no to very minimal bruising. 

To summarize: Dr. Cangello always begins with a closed approach. Very infrequently does he find the need to open the nose. Through the closed approach, he is able to modify the dorsum and tip and see the effects of the changes made instantaneously because the skin does not need to be redraped. This is different from the open approach where the skin does have to be redraped and sutured closed in order to see the shape of the nose after the  bone and cartilage have been altered. Further, by using the closed approach certain ligamentous structures which provide support to the tip are maintained. These ligaments all have to be reconstructed when the open approach is used. If this is not done properly, this can lead to fullness in the supratip area (no supratip break) and the appearance of a nasal tip that is not sufficiently projected. 

Additionally, the methods Dr. Cangello  uses in his approach to rhinoplasty are minimally traumatic. In many cases, particularly with respect to Preservation Rhinoplasty, NO skin needs to be dissected off the dorsum of  the nose (this is the complete opposite of what must happen in “open” rhinoplasty cases). Limited incisions and dissection of the nose result in minimal swelling and usually NO bruising, which leads to much quicker recovery. Patients often tell Dr. Cangello that they are shocked that they didn’t bruise at all and barely had any swelling in their post-operative period. 

As for patients wondering which approach is best for them: Dr. Cangello always tells patients that the scar that results from using the open approach is essentially inconsequential. If the surgeon is meticulous about creating the incision and closing it, it should heal very inconspicuously.  So you should not be deterred if your surgeon tells you he is using an open approach. If, however, a surgeon plans to use a closed approach, you should be certain that ALL of the aesthetic issues of the nose (particularly of the lower third) will be addressed, because all too often they are not.  In addition, you should look at before and after photos to see if they are addressed adequately. The absence of an external scar on the nose is great in theory, but it certainly doesn’t make a difference if the overall shape of the nose is sacrificed simply so that one can avoid  having a scar. Dr. Cangello is extremely unique in his ability to be able to utilize the closed rhinoplasty approach in most of his patients while also providing the most beautiful and natural results.