The ways of rhinoplasty. Comparing philosophies

Rhinoplasty is certainly the most creative and exciting intervention in the field of plastic surgery because of the possibility of associating technical procedures with the surgeon's inventiveness and artistic sense. In addition, the position of the nose in the center of the face made of its change in social relationships have made this intervention the protagonist among all cosmetic surgery from the beginning. Starting from these assumptions it is understandable how in recent years there has been the publication of many books with the intent to teach how to operate, move the steps in the procedures, learn the surgical anatomy, what to consider the best technique to adopt.

The large number of proposals in the scientific literature has mostly referred initially to the closed approach and later to the open approach starting especially from the 90s. In fact, these two strands have distinguished themselves not only for the access incisions but especially for a different general programming philosophy. The former founded more on a reduction of the nasal components, the latter more on a structural remodeling and the use of grafts. In reality, this initial conceptual dichotomy, in recent years, has been significantly attenuated by the more frequent use of structural principles with the use of grafts by the "closers" and has a greater essentiality with more motivated indication of grafts by the "openers". Moreover, it should be noted recently, from many quarters, a greater revaluation of the closed approach with the use of concepts of "structural rhinoplasty", typical of the open approach.

To these two philosophies, very recently, another one has been added, that of "preservation rhinoplasty" that, from the observation of the numerous damages caused by an exaggerated surgical overkill, wanted to propose a less aggressive and more conservative philosophy. On this conceptual basis, preservation has represented, with a precise codification, the techniques of push down and let