The incision across the columella is located at its narrowest part, in a staggered or inverted V. This incision is continued symmetrically on both sides of the columella, where crus medialis is very close to the skin and can be damaged. It extends along the caudal edge of the lateral crus without damaging the “triangle of soft tissue.”
Dissecting tip must be done very carefully and in suprapericóndrico plane while the back portion of the bone will subperiosteal dissection. The septum we approach it from the caudal portion.

Its main advantages are: allows a direct view of the operative field, a diagnosis intra-operative accurate, operate with both hands, more precisely in carrying out the various procedures and obtaining more predictable results and durable because it allows us to ensure the position of the modified structures and prevent deformities caused by scarring. Furthermore, its anatomical view, it facilitates the teaching of the various rhinoplasty procedures.
In contrast, disadvantages are: a visible external scars, surgical time, prolonged edema and longer anesthesia in the nasal tip. Furthermore, we must always bear in mind the significant alteration of blood circulation of the nasal tip, which is some risk of necrosis skin, columella or tip.

Usually the most it used by surgeons and offers a great advantage technique: there is no visible scar. It is accessed cartilage, septum or the area on which it should do some action through the nostrils, thus intervention is settled without external incisions, and is much more comfortable in the long term for the patient, the fact not seen with any brand of intervention. The surgeon has access to the most problematic areas in this way, you can mold section to make the nose having the desired shape.

It is a complex intervention, but add the possible complications of deformities caused by an earlier intervention; its own which carries the second or third revision.
This must be warned to the patient before surgery, since it must be prepared to accept a new surgery if necessary. Moreover, depending on the severity of deformity caused by rhinoplasty which improvement is expected, the effect can be dramatic to the point it reaches psychically unbalancing the patient or at least alter the relationship and confidence in the surgeon with consequent problems involved.

Similarly, it is necessary to wait the necessary time has passed the normal process of cicatrizcion to make a new and thus reduce complications, which range about 30%. The waiting time varies from 6 months to a year, even two years when there have been more than two previous surgeries.
The Rhinoplasty Secondary requires, of course, a thorough knowledge of both anatomy and physiology as normal anatomical changes and functional alterations that can lead to a Rhinoplasty. It also requires careful surgical technique and possessing sufficient resources so that we can implement the various procedures for the correction of each deformity. Your choice must be made with extreme caution and always aimed at achieving the result we have in mind.