--- title: "Rhinoplasty Incisions - Types, Indications, Advantages & Disadvantages" description: "ENT notes on Rhinoplasty Incisions." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/rhinoplasty-incisions-transcolumellar-marginal-intercartilaginous-incision" categories: ["Rhinology", "Surgery"] video: "https://www.youtube.com/watch?v=OZwUWt3CvxQ" image: "https://media.theentresident.com/og-images/rhinoplasty-incisions-transcolumellar-marginal-intercartilaginous-incision.png" --- # Rhinoplasty Incisions - Types, Indications, Advantages & Disadvantages ENT notes on Rhinoplasty Incisions. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=OZwUWt3CvxQ ## 👃 Incisions in Rhinoplasty The choice of incision in rhinoplasty depends on: * Surgical approach (open or closed) * Type of deformity * Need for exposure * Whether it is a primary or revision surgery * Presence of tip involvement * Preference of the surgeon --- ### 📋 Classification of Incisions in Rhinoplasty | Approach | Incisions | | --- | --- | | **Open (External) Rhinoplasty** | Transcolumellar incision, Alar incision | | **Closed (Endonasal) Rhinoplasty** | Intercartilaginous incision, Transcartilaginous incision, Infracartilaginous (Marginal) incision, Transfixion incision | --- ### 1- Intercartilaginous Incision #### 📍 Site Placed internally in the **soft tissue scroll area**, between the **caudal margin of the upper lateral cartilage** and the lower lateral cartilage. 👉 The incision runs **parallel to and just above the lower lateral cartilage**. #### 📌 Indications * Dorsal hump reduction * Nasal bone osteotomies * Cases with **limited tip involvement** or minor tip refinement * Can be combined with the **transfixion incision** for full endonasal access ⚠️ Not preferable for major surgery involving the tip. > What are the advantages and disadvantages of Intercartilaginous Incision? --- ### 2- Transcartilaginous Incision #### 📌 Also Known As 👉 Intracartilaginous Incision #### 📍 Site Made **through the substance of the lower lateral cartilage (alar cartilage)**. * Given **3 to 5 mm caudal to the cephalic end** of the lower lateral cartilage * Placed **parallel to the caudal border of the lateral crus** of the alar cartilage > What are the parts of the alar cartilage? #### 📌 Indications * Trimming the **cephalic end of the lower lateral cartilage** for tip refinement * Bulbous or boxy nasal tip > What are the advantages and disadvantages of Transcartilaginous Incision? --- ### 3- Infracartilaginous Incision #### 📌 Also Known As 👉 Marginal Incision 👉 Rim Incision #### 📍 Site Given along the **caudal border of the lower lateral cartilage**, inside the nostril rim. 👉 Starts at the **medial crural footplate** and extends towards the **alar rim**. #### 📌 Indications * Tip rhinoplasty requiring full access to the lower lateral cartilage * Asymmetric tip or complex tip deformity * Delivery technique for cartilage grafting > What are the advantages and disadvantages of Infracartilaginous Incision? --- ### 4- Transfixion Incision #### 📍 Site Made through the **membranous septum in the columella**, between the **medial crura of the lower lateral cartilage** and the **caudal septum**. > What is the anatomy of the nasal septum? > What are the variants of the Transfixion Incision? #### 📌 Indications * Concurrent septoplasty, as in **septorhinoplasty** * Caudal septal resection * Reduction of the nasal spine * Columellar shortening * Tip deprojection, as in an over-projected nose > What are the advantages and disadvantages of Transfixion Incision? --- ### 5- Transcolumellar Incision ⭐ The most commonly used incision in **open (external) rhinoplasty**. #### 📍 Site An **external incision placed transversely across the columella**, commonly combined with **bilateral marginal incisions** inside the nose. > What are the different Types of Transcolumellar Incision? #### 📌 Indications The indications for open rhinoplasty are the indications for this incision: * Complex deformity * Revision rhinoplasty * Cleft nose * Severe tip asymmetry * Major reconstruction * Extensive grafting * Teaching purposes ⭐ The external approach gives students good visual access, so it is well suited for teaching. > What are the advantages and disadvantages of Transcolumellar Incision? --- ### 6- Alar Incision #### 📍 Site An **external incision placed at the alar facial groove**, the junction of the ala with the cheek or upper lip. 👉 Placed entirely **outside the nostril**. #### 📌 Indications 1- Wide Alar Base 2- Excessive Alar Flaring > What are the advantages and disadvantages of Alar Incision? --- ### ⭐ High Yield Rapid Revision Table | Incision | Approach | Site | Key Point | | --- | --- | --- | --- | | Intercartilaginous | Closed | Scroll area, between upper and lower lateral cartilages | Wide access to dorsum and bony vault, limited tip access | | Transcartilaginous | Closed | Through the lower lateral cartilage, 3 to 5 mm caudal to its cephalic end | Good for controlled cephalic trim | | Infracartilaginous (Marginal) | Closed | Along the caudal border of the lower lateral cartilage | Allows complete delivery of the lower lateral cartilage | | Transfixion | Closed | Through the membranous septum in the columella | Best exposure of the caudal septum and nasal spine | | Transcolumellar | Open | Transversely across the columella | Most common incision in open rhinoplasty | | Alar | Open | Alar facial groove | Used for a wide alar base and alar flaring | --- ### ⭐ Exam Pearls - Incisions in rhinoplasty are classified by **open** and **closed** approach - Transcartilaginous incision is also known as the **intracartilaginous incision** - Transcartilaginous incision is given **3 to 5 mm caudal to the cephalic end** of the lower lateral cartilage - Infracartilaginous incision is also known as the **marginal** or **rim incision** - Complete transfixion incision disrupts the **tip support mechanism** - Most common incision in open rhinoplasty → **Transcolumellar incision** --- ## About This Note This free ENT note on Rhinoplasty Incisions - Types, Indications, Advantages & Disadvantages was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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