• The transfixion and hemitransfixion incision provide access to the caudal septum in endonasal rhinoplasty. The complete transfixion incision separates the medial crura from the septum. The hemitransfixion incision is only made on one side, and usually stops short of the anterior nasal spine, preserving tip support. The nasal dorsum is not approached with the transfixion incision. The transcolumellar incision is used in an open approach and is not normally combined with either the transfixion or hemi-transfixion incision.
  • Spreader Graft: The internal nasal valve is formed by the junction of the upper lateral cartilage and the nasal septum. Spreader grafts are placed to increase the size of this junction, hence improving nasal airway breathing, and in some cases, nasal esthetics.
  • The intercartilagenous incision is used to access the nasal dorsum when little or no tip alteration is necessary in the closed rhinoplasty approach. The intracartilagenous approach will facilitate a cephalic trimming of the lower lateral cartilage. A marginal incision combined with a transcolumellar incision is used for the open rhinoplasty. Complete tip exposure, particularly to view the lower lateral cartilages in their correct anatomic position is best done with the open approach.