Closed Rhinoplasty by Dr. Vladimir Grigoryants

Why Closed Rhinoplasty?

Dr. Grigoryants performs both closed rhinoplasty and open rhinoplasty but prefers the closed technique for primary rhinoplasty. He uses open rhinoplasty for some revision cases after a previous open rhinoplasty.  Closed rhinoplasty avoids a cut and a scar across the bottom middle portion of the nose, called the columella.  With open rhinoplasty, an incision is made across the columella, resulting in a scar. Although this scar may heal well, in some patients it can remain visible, notched, or thickened.

Examples of poorly healed open rhinoplasty scars: These patients presented to Dr. Grigoryants for revision rhinoplasty after undergoing open rhinoplasty elsewhere. The patient on the left had a notched columellar scar, and the patient on the right had a thickened columellar scar.

This patient underwent closed rhinoplasty by Dr. Grigoryants. No scar is present across the columella.

Can the Tip Be Refined With Closed Rhinoplasty?

Yes. Dr. Grigoryants uses a closed rhinoplasty technique, which allows him to reshape the tip and rest of the nose under direct visualization, very similar to open rhinoplasty. Instead of cutting across the columella and lifting the nasal tip skin, Dr. Grigoryants moves the tip skin to the side through incisions hidden inside the nose. This allows him to directly visualize the tip cartilages while reshaping them, perform dorsal reshaping, add support grafts where necessary, and perform septoplasty, all under direct visualization. There are older closed rhinoplasty techniques that do not allow for tip visualization and should rarely be performed today.

This patient underwent rhinoplasty elsewhere. Dr. Grigoryants performed a closed revision rhinoplasty to refine the tip of the nose, reshaped the dorsum, and open the nasal airways.

An Additional Advantage: Seeing the Tip With the Skin in Place

Another advantage of closed technique is that the skin remains over the nasal tip during much of the reshaping process.

Because the tip skin remains in its natural relationship with the underlying cartilage, Dr. Grigoryants can better assess how changes in the tip cartilages translate into the actual external shape of the nose as he narrows, repositions, and supports the tip.

With an open approach, the tip skin is elevated away from the underlying cartilages during much of the operation,  requiring the surgeon to repeatedly move the skin back over the cartilages to evaluate the shape. Dr. Grigoryants considers preservation of this skin-cartilage relationship an important advantage of closed technique because it provides continuous visual feedback.

The advantages of Dr. Grigoryants’ closed rhinoplasty technique are:

• No external columellar scar
• Direct visualization for precise structural reshaping of the nose
• Better ability to assess the external tip contour during reshaping

What about breathing?

Rhinoplasty is not only about the appearance of the nose. The nasal airway and breathing should also be evaluated and addressed when necessary. Dr. Grigoryants has seen patients for revision rhinoplasty who previously underwent cosmetic rhinoplasty elsewhere but continued to have difficulty breathing. In some of these patients, examination revealed a significantly deviated nasal septum or other structural airway problems that were not addressed in the previous surgery.

During rhinoplasty, Dr. Grigoryants evaluates both the appearance and function of the nose. While cosmetically reshaping the nose, he also addresses a deviated nasal septum via septoplasty, reduces enlarged inferior turbinates, and repairs or supports the nasal valves when necessary. When performing rhinoplasty, an important goal must be maintaining or improving the patient’s ability to breathe.

High Volume Rhinoplasty Experience

Dr. Grigoryants performs rhinoplasty surgery every day, Monday through Friday, and he is one of the busiest rhinoplasty surgeons worldwide. Rhinoplasty is one of the most technically challenging procedures in plastic surgery. Consistently performing a high volume of rhinoplasty procedures provides extensive experience with different nasal anatomies, skin thicknesses, breathing problems, and surgical complexities. Dr. Grigoryants believes that extensive rhinoplasty experience and a high-volume practice are important factors in achieving consistent results and minimizing the likelihood of revision surgery.

Internationally Recognized Rhinoplasty Expert

Patients travel to Los Angeles from across the United States and from many parts of the world specifically to undergo rhinoplasty with Dr. Grigoryants. His busy rhinoplasty practice has grown largely through word-of-mouth referrals from satisfied patients, including patients who refer their friends and family members.

Dr. Grigoryants has performed rhinoplasty on a number of celebrities. He was selected to perform rhinoplasty on The Real Housewives of Beverly Hills, where the consultation and surgery were featured on the television show. Dr. Grigoryants has also performed rhinoplasty on physicians and their relatives, including family members of plastic surgeons who personally referred their close relatives to Dr. Grigoryants for rhinoplasty. These professional referrals are particularly meaningful because they come from physicians and surgeons who understand the complexity of rhinoplasty and the experience required to perform it.

Surgery in a Hospital-Affiliated Surgical Center

Dr. Grigoryants performs his rhinoplasty procedures primarily at a hospital-affiliated surgical center. Being part of the hospital, the surgical center provides a high level of patient safety with modern operating-room and anesthesia equipment, established safety protocols, experienced operating-room nurses, and physician anesthesiologists who monitor patients throughout surgery. Dr. Grigoryants believes that performing rhinoplasty in a hospital-affiliated surgical environment with an experienced surgical and anesthesia team provides an important additional level of safety for his patients.

Recognized Expertise Among Plastic Surgeons

Dr. Grigoryants serves as a peer reviewer for Aesthetic Plastic Surgery, an international peer-reviewed journal in plastic surgery. In this role, he is asked to evaluate rhinoplasty and other plastic surgery manuscripts submitted by fellow plastic surgeons, reviewing their surgical techniques, scientific merit, and clinical findings before they are considered for publication.

To schedule your rhinoplasty consultation with Dr. Grigoryants, please call our office at 818 396-5551 or email vgplasticsurg@gmail.com . It is best to speak with our office assistant directly or email our office. Please avoid leaving messages on our answering machine, as the messages sometimes are not clear.

Additionally, an initial rhinoplasty consultation can be done virtually.  Please email your face pictures (front, side, and bottom views) to Dr. Grigoryants at vladgrigor@gmail.com , and he will reply to you with more information.