Open Rhinoplasty
The visible incision is usually across the columella (the column of flesh that separates the nostrils) in the fashion of "step" or stair" and even sometimes an inverted "V". When there is reconstruction of an older keloidal or prominent scar there may be a "Z" incision or "Z-plasty" instead. Either way the skin and thin fat layer overlying the cartilages and bone is pulled back and secured with a device called a retractor that looks like a modified shoe horn or better yet, a nasal crowbar or sorts. This actually looks a bit gruesome and you'd never think that your tissues will look normal again after this type of tissue 'torture' but it does. The skin is very resilient in most people and can "bounce back" to its original state with only the slight scar as evidence.
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