Chapter 5 - Incisions and Approaches

Incisions are methods of gaining access to the bony and cartilaginous structures of the nose and include transcartilaginous, intercartilaginous, marginal, and transcolumellar incisions. Approaches provide surgical exposure of the nasal structures including the nasal tip and in ­clude cartilage-splitting (transcartilaginous incision), retrograde (intercartilaginous inci­ sion with retrograde dissection), delivery approach (intercartilaginous, marginal incisions), and external (transcolumellar and marginal incisions). Based on an analysis of the individ­ ual patient's anatomy, appropriate incisions, approaches, and tip-sculpturing techniques are selected (1) (Appendix E).

In this section, a transcartilaginous incision is performed on one side. Then an intercar­tilaginous and marginal incision is made on the other side to deliver that cartilage. Next, proceed with the external rhinoplasty approach. Following these instructions will allow an experience with several incisions and approaches in a single specimen.