Comparison of External and Internal Osteotomy Outcomes Results in Rhinoplasty

Background: Rhinoplasty procedures have significantly increased over recent years. Lateral osteotomy is a critical step in shaping the nasal bony pyramid. This study aims to determine the optimal osteotomy technique—internal (transmucosal) or external (transcutaneous)—that achieves superior aesthetic and functional outcomes with fewer complications. Materials and Methods: An analytical study was conducted at Al-Mouwasat University Hospital in Damascus between January 2021 and January 2024. A total of 39 patients undergoing open rhinoplasty were enrolled and divided into two groups: 15 patients underwent external lateral osteotomy, and 24 underwent internal osteotomy. Functional, aesthetic, and complication-related outcomes were assessed using structured questionnaires and standardized scales. Results: The mean age of participants was 25.87 years, with 66.7% being female. Postoperative satisfaction scores were significantly higher in the internal osteotomy group (p = 0.032), while complication scores showed no significant difference between the groups (p = 0.908). Most patients reported mild or rare respiratory symptoms postoperatively. Ecchymosis occurred in 64.1% on the first postoperative day and decreased over time. Both techniques proved effective and safe, with a slight aesthetic and functional preference for the internal approach. Conclusion: Both internal and external lateral osteotomy techniques are safe and effective in rhinoplasty. However, the internal method may offer better aesthetic and functional satisfaction in selected patients.