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Rhinoplasty is a delicate operation. Many plastic surgeons do not even perform rhinoplasty because it requires rigorous planning, precise technique and understanding of how surgery today will appear even years later, as the nose continues to heal and change. These skills require extensive surgical experience that very few surgeons have mastered. Through over two decades of surgery and thousands of rhinoplasties, Dr. Rawnsley has acquired the understanding and skill in rhinoplasty and created “Soft Touch Rhinoplasty.” This approach gently reshapes the nose from the inside. “Soft Touch Rhinoplasty” respects the structural integrity of the nose, reduces healing time, creates a natural, long-lasting result without a scar.

Traditional rhinoplasty was always a reduction procedure, where cartilage and bone were dissected and removed, often at odds with the fact that the nose is a living and breathing organ. When the structure of the nose is aggressively destabilized and weakened, the appearance and function can be compromised over the long term. Dr. Rawnsley’s philosophy toward rhinoplasty is conservative, preserving cartilage and the natural structure of the nose whenever possible. Tip cartilages are reshaped, instead of just removed. Nasal bridge structures are reconstructed after being made smaller. The delicate structures of the nose are approached from inside the nose (“endonasal” or “closed”), rather than through the skin at the base of the nose (“open” or “external”), whenever possible.

Dr. Rawnsley feels strongly that your appearance after rhinoplasty should be a natural one, and not “surgerized.” Patients’ desire to have surgery to improve one’s appearance should not result in looking as if they have had surgery. This principle guides Dr. Rawnsley’s aesthetic judgement. To help patient’s gain a realistic expectation of results for their rhinoplasty, Dr. Rawnsley uses digital morphing technology with every patient. This allows Dr. Rawnsley both to share his aesthetic vision and understand and analyze his patient’s needs.

Also known as “Scar-less Rhinoplasty,” the “Closed” approach leaves no visible scar as all incisions are made inside the nose. About 85% are candidates for the closed or endonasal approach to rhinoplasty. The other 15% require an “open” approach. Dr. Rawnsley performs rhinoplasty through an “open” approach for severe asymmetries, difficult tip deformities or, more often, for corrective revision rhinoplasty surgery to improve other surgeons’ work.

So what’s the difference between “Open” and “Closed” Rhinoplasty?

“Open” Rhinoplasty, technically called “External” Rhinoplasty, has become a popular approach in which the columellar skin between the two nostrils is cut, allowing the surgeon to lift the nasal skin back to expose the entire structure of the nose. Many surgeons use this approach because it is technically easier to learn. While this approach is useful in the more difficult nose, this greater visibility comes with its costs. Though the surgeon is then able to see exactly what he is doing, what he isn’t able to see is how each cut and shaving is affecting the overall outcome due to the increased swelling and distortion that occurs with this approach. This approach leads to more prolonged swelling after surgery as well. While the scar left in the skin between the nostrils is usually acceptable, occasionally it is prominent and requires revision.

“Closed” Rhinoplasty, technically called “Endonasal” Rhinoplasty, requires that the surgeon operate through an incision inside the nose, with a much more limited view. This technique is much more difficult to learn, and requires years of experience to perfect. This method has some advantages, however, including the surgeon’s ability to immediately and more accurately see and adjust the results of rhinoplasty while in surgery, allowing both technique and visual aesthetics to guide the procedure. The natural and stabilizing attachments of the skin to underlying structures can be maintained as much as possible, resulting in more consistent results. After endonasal rhinoplasty, swelling is less and there is no visible scar.

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