In the 20th century, 2 major divisions of rhinoplasty emerged. Initially, the septum and the supporting cartilages of the nose were tackled without exposing the nasal dorsum to direct vision. This technique gained the unfortunate and incorrect name of closed rhinoplasty as if the cartilages could not be seen or manipulated. The current term endonasal septorhinoplasty adequately describes this technique, and the former term closed should no longer be used. With the meteoric rise of open or external rhinoplasty in the 1970s, the former endonasal techniques were almost totally abandoned, especially in the United States. By the end of the 20th century it became apparent that the pendulum had swung too far in favor of the external approach and that most patients would benefit from endonasal surgery.
A patient who had undergone previous cleft lip repair and 2 previous rhinoplasties. A, Preoperative frontal view. B, Postoperative frontal view.
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