External Marginal Approach Rhinoplasty (EMA Rhinoplasty)

  • Peter Chanwoo Kim
  • Dae Hwan Park


Background: Open rhinoplasty has been the mainstream rhinoplasty era up to now. Open rhinoplasty supposedly has the great advantage of giving the surgeon better vision and access. However, the columellar scar is one of the worst disadvantages of open rhinoplasty. For patients seeking beauty of the nose, the columellar scar, which marks the operative procedure, is undesirable.

Closed rhinoplasty has several advantages such as less swelling and an undetectable scar. However, this technique also has drawbacks, such as limited operative field. Modified open rhinoplasty without transcolumellar incision is introduced here as an extended marginal approach. This extended marginal approach can achieve the best of both the open and closed techniques.

The modified incisional technique allows almost the same exposure as that of the open rhinoplastic field, but involves no transcolumellar incision. Autologous graft is the best choice of rhinoplasty with this modified extended endonasal approach. Extended marginal approach rhinoplasty can replace traditional open rhinoplasty.


Nasal Bone Orthognathic Surgery Lateral Cartilage Lower Lateral Cartilage Open Rhinoplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We gratefully acknowledge and thank Gemma Seung Jung Son (BA), medical illustrator in our department, and Letitia An (B.Sc.), a good friend of mine from New Zealand. Miss Gemma dedicated all the illustrations in this article to make this chapter a work of art as only she can do. Miss Letitia gave us continued and tireless dedication to help make this chapter a high-quality English publication. They were instrumental in transforming this text from a dream to reality.


  1. 1.
    Baser B, Hiranandani N, Grewal DS (1989) External rhinoplasty in the tropics. J Laryngol Otol 103:1198PubMedCrossRefGoogle Scholar
  2. 2.
    Sevin A, Sevin K, Erdogan B, Deren O, Adanali G (2006) Open rhinoplasty without transcolumellar incision. Ann Plast Surg 57(3):252–4. PubMed PMID:16929188PubMedCrossRefGoogle Scholar
  3. 3.
    Holmström H, Luzi F (1996) Open rhinoplasty without transcolumellar incision. Plast Reconstr Surg 97(2):321–326. PubMed PMID: 8559814PubMedCrossRefGoogle Scholar
  4. 4.
    Guerreosantos, J. Open rhinoplasty without skin-columella incision. Plast. Reconstr. Surg. 85:955PubMedCrossRefGoogle Scholar
  5. 5.
    Bravo FG, Schwarze HP (2008) Closed-open rhinoplasty with extended lip dissection: anew concept and classification of rhinoplasty. Plast Reconstr Surg 122(3):944–50. PubMed PMID: 18766064PubMedCrossRefGoogle Scholar
  6. 6.
    Han SK, Woo HS, Kim WK (2002) Extended incision in open-approach rhinoplasty for asians. Plast Reconstr Surg 109(6):2087–96. PubMed PMID: 11994619PubMedCrossRefGoogle Scholar
  7. 7.
    Peter Chanwoo Kim, Chang Hyung Oh, Yong Jig Lee, Jeong Su Shim MD, Dae Hwan Park, (2009) Measurement of Septal Cartilage Amount using Sagittal view of facial bone CT. MJCUD (1) 67–70PubMedCrossRefGoogle Scholar
  8. 8.
    Cárdenas-Camarena L, Guerrero MT (2002) Improving nasal tip projection and definition using interdomal sutures and open approach without transcolumellar incision. Aesthetic Plast Surg 26(3):161–6. PubMed PMID: 12140692PubMedCrossRefGoogle Scholar
  9. 9.
    Peter Chanwoo Kim, Sang Soon Park, Yong Jig Lee, (2011) Simultaneous Non-transcolumellar Incisioned Rhinoplasty in Nasal Bone Fracture : Analysis of 121 Cases. Korean Aesth Plast Surg 17(3):165–172PubMedCrossRefGoogle Scholar
  10. 10.
    Yilmaz S, Ercocen AR, Can Z, et al (2001) Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 108:1054–1060; discussion 1061–1052PubMedCrossRefGoogle Scholar
  11. 11.
    Coskun BU, Seven H, Yigit O, et al (2005) Comparison of diced cartilage graft wrapped in surgicell and diced cartilage graft wrapped in fascia: an experimental study. Laryngoscope 115:668–671PubMedCrossRefGoogle Scholar
  12. 12.
    Calvert JW, Brenner K, DaCosta-Iyer M, et al (2006) Histological analysis of human diced cartilage grafts. Plast Reconstr Surg 118:230–236CrossRefGoogle Scholar
  13. 13.
    Brenner KA, McConnell MP, Evans GR, et al (2006) Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg 117:105–115, Oly 1658–1659PubMedCrossRefGoogle Scholar
  14. 14.
    Peer LA (1954) Extended use of diced cartilage grafts. Plast Reconstr Surg14:178–185PubMedCrossRefGoogle Scholar
  15. 15.
    Coster DJ, Galbraith JE (1980) Diced cartilage grafts to correct enophthalmos. Br J Ophthalmol 64: 135–136PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryDaegu Catholic University Medical CenterNamgu, DaeguKorea
  2. 2.Department of Plastic and Reconstructive SurgeryCatholic University of DaeguDaeguKorea

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