Closed Rhinoplasty Approach
The approach Dr. William Portuese takes for rhinoplasty or nose surgery is using a closed approach, meaning he does not make an incision outside of the nose to the internal work. He is an expert in this technique and uses is for anything from a dorsal hump to a broken nose.
"Patients often ask me what a rhinoplasty surgery is like. And I tell them, I perform closed rhinoplasty with all the incisions placed on the inside of the nose. There's no packing placed on the inside of the nose either. And all the stitches are dissolvable. Basically, we are sculpting the bone and the cartilage underneath the skin in order to affect the change. Such as shaving down the dorsal hump. narrowing the bulbous nasal tip.

Sometimes we're adding a cartilage graft, such as a spreader graft, to make sure that the upper lateral cartilages don't collapse inward during the healing process. Sometimes we're removing a conservative amount of cartilage from the nasal tip when it's bulbous. Sometimes we're putting suture techniques applied to those lower lateral cartilages of the nasal tip. But it's important to understand that the nose is a three-dimensional structure. And rhinoplasty is performed in all three dimensions. That's why the nose has to look good in all three dimensions. And it has to also breathe properly out of both sides of the nose. "