The Plastic and Aesthetic Surgery
at Clinic Tsope since 1956


The description of endonasal rhinoplasty: The Closed Approach

Endonasal or closed rhinoplasty was introduced by Doctor Tsope – Vakhtang Khutsidze in 1956. The closed approach in rhinoplasty is made through the nostrils without making any external incisions.

All of the surgical incisions are positioned deep inside the nostrils on the mucous membrane in the area of nasal domes and nose wings, which gives the surgeon an opportunity to peel the skin off from the carcass of nose for further manipulation. The peeled skin is lifted and fixed using special endoscopic instruments in such a way that the surgeon can freely observe the osteochondral frame of nose, including the radix. Although the nose carcass visibility is 100%, the surgeon is free to use a video camera for observing the image on the monitor. Moreover, during the surgery, certain stages of dorsum carcass correction might require usage of endoscopic instruments.

Interesting and comfortable endonasal instruments were invented throughout the practice of Doctor Tsope, which have not been patented or described in his scientific works, as in the Soviet times, in 1960-80s, plastic surgery was not regarded seriously and was considered a medical sphere that had no connection with the health of a person. Imported surgical instruments could always be found among the working surgical kits of Doctor Tsope, which he was able to bring with him after travelling abroad.

While working with the tip of the nose using the endonasal approach, surgeon enters the surgical field as if from the inside, seeing the anatomy of the nose tip in a different perspective. Without being too specific, they say that the invention of assembly line by Henry Ford was made with the help of unconventional thinking of this sort. Instead of asking a usual question: How to get the working force to the materials that need to be worked on? Ford asked: How to bring the work to the people?” This fresh approach gave birth to the successful idea of the conveyor.

During an open or external rhinoplasty approach the surgeon peels the skin off the nose by placing a horizontal incision across the columella and an incision on mucous membrane under the nasal tip and wing, which borders the skin of nostrils. After peeling the skin of the dorsum, the osteochondral frame of nose, up till the radix, is also totally visible, but, during the open approach the visibility of some zones of the nose tip is better. For this reason, in seldom, difficult cases of the anatomic structure of the nasal tip, the open approach in rhinoplasty is used together with the closed endonasal approach, which in my practice happens in up to 10% of all plastic nasal operation cases.

Human resources manage modern technologies and complex surgical instruments with various methods of rhinoplasty and in both cases - good results can be achieved, whether it be closed or open approach of the aesthetical rhinoplasty.

Zurab Khutsiddze