Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Open Versus Closed Septorhinoplasty Approaches for Postoperative Edema and Ecchymosis O ¨ ner Sakalliog˘lu, MD,  Cemal Cingi, MD, y Cahit Polat, MD,  Erkan Soylu, MD, z Abdulvahap Akyigit, MD,  and Hakan Soken, MD § Objective: The aim of this study was to compare periorbital edema and ecchymosis seen after closed (endonasal) and open (external) septorhinoplasty (SRP). Methods: In total, 50 patients undergoing hump extraction and osteotomies were allocated to 2 groups. Group 1 consisted of 25 patients who underwent closed SRP. Group 2 consisted of 25 patients who underwent open SRP. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on the first, third, and seventh postoperative days using a scale of 0 to 4 by the first author. Results: There was no statistically significant difference between the groups in terms of age, sex, or operation time. No significant difference was observed clinically or statistically in the scores of periorbital edema or ecchymosis between groups 1 and 2 on the first, third, and seventh postoperative days (P > 0.05). Conclusions: The authors observed no clinically or statistically significant difference in comparing periorbital edema and ecchymosis seen after closed and open SRP. Key Words: Complication, ecchymosis, edema, osteotomy, septorhinoplasty (J Craniofac Surg 2015;26: 1334–1337) S eptorhinoplasty is a commonly performed procedure in otorhi- nolaryngology practice. Periorbital edema and ecchymosis are common complications of this procedure. The main cause of these complications is bleeding into the soft tissue, due to lateral osteo- tomies. Periorbital edema and ecchymosis are annoying to the patient and may cause an increase in morbidity. Thus, a rapid recovery is important for the patients. Edema and ecchymosis can be reduced with careful surgical technique, but it is not possible to prevent them completely. Use of steroids to prevent the develop- ment of periorbital edema and ecchymosis has been documented previously. 1,2 Applying pressure on osteotomy sites, postoperative taping of the nose, head elevation, and periorbital cold pack application are also commonly used techniques. 3 The advantages and disadvantages of open (external) and closed (endonasal) rhinoplasties remain a subject of debate. 4 The open rhinoplasty approach presents obvious advantages for treating complex and difficult nasal deformities, but the incision crossing the columella and the ensuing scar can be troublesome aestheti- cally. 5 Through an open approach, surgeons can identify small anatomic differences not observable from the surface, operate with binocular vision, and use suture and fixation techniques that may be difficult or impossible endonasally. 6 Open rhinoplasty has the disadvantages of increased operative time, prolonged postoperative swelling, loss of nasal tip support if compensatory measures are not performed, and more profound scar contracture from completely degloving the nasal soft tissue, resulting in asymmetries revealed after long healing periods. 7 Advantages of the endonasal approach include decreased oper- ating times, more rapid recovery, and less significant scar contrac- ture. 7 The advantages of closed over open rhinoplasty are that a closed rhinoplasty does not produce a transcolumellar scar; there is less subcutaneous fibrosis; tip vascularity is preserved; time to recovery is shortened. 8 There is a significantly greater loss of nasal tip projection in an open versus a closed rhinoplasty. 9 The closed approach to rhinoplasty has fallen out of favor because of the misconception that nasal tip cannot be symmetrically molded except by direct vision through a divided columella. On the con- trary, the open approach could be championed for anterior septal deviation, but this similarly can be easily overcome by access through nostril. There is no intrinsic reason to avoid the open approach, but it is more invasive requiring a wider dissection; cartilage grafts are used more liberally; it tends to make the operation longer even in the best of hands. 10 The experience of the surgeon plays an important role in dictating whether a closed or open approach is ultimately per- formed. Closed rhinoplasty can be much riskier than an open rhinoplasty, especially in the hands of an inexperienced surgeon. 8 A surgeon’s experience and artistic sense are essential for the closed technique, in which most of the corrections are made without exposing the nasal frame. The open technique allows a greater operating range with a direct view of the nasal structure, resulting in improved precision in modeling the cartilages. 11 The open tech- nique provides wide exposure but a columellar incision scar results. Thus, some surgeons prefer the closed technique, particularly in primary rhinoplasty. With the closed approach, no columellar incision scar results, but the exposure is poor compared with the open technique. 12 It has been argued that the final result of an open rhinoplasty is not superior to that of a well-done endonasal pro- cedure, and one of the major disadvantages of the open technique is the visible columellar scar. 13 Thus, open versus closed rhinoplasty has been a controversial subject for several years, and both approaches have advantages and disadvantages. The aim of this study was to compare periorbital edema and ecchymosis seen after closed and open septorhinoplas- ties. To our knowledge, no direct comparison of closed versus open From the  Elazig Training and Research Hospital, Otorhinolaryngology Clinic, Elazig; y Eskisehir Osmangazi University, Otorhinolaryngology Department, Eskisehir; z Medipol University, Otorhinolaryngology Department, Istanbul; and § Eskisehir Military Hospital, ENT Depart- ment, Eskisehir, Turkey. Received February 28, 2014. Accepted for publication October 5, 2014. Address correspondence and reprint requests to O ¨ ner Sakalliog ˘lu, MD, Elazig ˘ Eg ˘itim Aras ¸tirma Hastanesi, Kulak Burun Bog ˘az Hastaliklari Klinig ˘i, Elazig ˘, Turkey; E-mail: onersakallioglu@yahoo.com The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001715 CLINICAL STUDY 1334 The Journal of Craniofacial Surgery  Volume 26, Number 4, June 2015