Last Friday marked Arbor Day, a unique and meaningful holiday—especially if you happen to be in Nebraska, where this day is a state celebration and an official holiday. As a plastic surgeon whose academic journey began with a degree in biology and chemistry, I’ve always had a deep appreciation for the natural world. Trees, in particular, have held a special place in my heart. They are not only vital to our planet’s health, but also a quiet reminder of resilience, growth, and renewal—qualities we strive to emulate in our work as reconstructive and aesthetic surgeons.

Arbor Day began in 1872, thanks to J. Sterling Morton, a Nebraska newspaper editor and agriculture enthusiast. He saw firsthand the starkness of the treeless prairie and advocated for tree planting as a way to enrich the land and lives of the people. On that first Arbor Day, Nebraskans planted over a million trees. Today, this day is celebrated nationwide and in many countries around the world.

Why celebrate trees? Because they do far more than decorate the landscape. They clean our air, stabilize our climate, protect soil from erosion, and support biodiversity. They offer shade, peace, and a sense of permanence in an ever-changing world. In medicine, particularly plastic surgery, we often borrow metaphors from nature. Like trees, the human body can be pruned, supported, and guided to heal. Like trees, our patients undergo seasons of change—sometimes bare and vulnerable, then flourishing again.

Arbor Day reminds me that while we shape faces and bodies, nature quietly shapes us. Let us carry the lessons of the forest into our practices: patience, balance, and reverence for life’s organic beauty.

So here’s to the trees—and to the surgeons who recognize that the art of healing is rooted in nature.

Enjoying nature in Kiawah, South Carolina, Dr. Ekstrom pausing under a live oak tree covered with Spanish Moss.

Dr. Ekstrom enjoying the National Botanical Garden in Washington, DC

Dr. Ekstrom enjoying biodiversity on a nature walk outside of Medellín, Colombia

As someone who has performed rhinoplasty for more than 40 years, I’ve seen the evolution of surgical techniques firsthand. Early in my career, I was trained in the closed rhinoplasty technique—a time-tested approach that involves making all incisions inside the nostrils. As the open technique became more popular, I adopted it as well, and for some time, used both depending on the case.

Today, however, I perform the vast majority of my rhinoplasties using the closed approach—and with excellent results.

So, what’s the difference?
Open rhinoplasty involves a small external incision across the columella (the tissue between the nostrils), allowing the skin to be lifted for a full view of the nasal structures. This gives the surgeon exceptional visibility and is especially helpful for complex cases or revisions. However, it can come with some drawbacks: more noticeable swelling, slower resolution of scar tissue, and the possibility of a small visible scar. Open rhinoplasty also requires a much longer time in the operating room under anesthesia for the patient, adding to the patient’s total cost for the procedure.

Closed rhinoplasty, by contrast, avoids any external incisions. The work is done entirely through the nostrils, which means no visible scars and generally less swelling and edema. Healing tends to be faster, and patients often return to normal activities sooner.
For most of my patients, the closed approach provides outstanding results with the added benefits of a quicker surgical procedure, faster recovery, minimal swelling, and no visible scars. Of course, every nose is unique, and in some complex cases, an open approach may be the better option. But with decades of experience in both techniques, I can confidently tailor the procedure to each patient’s needs.

If you’ve been thinking about rhinoplasty, I’d be happy to discuss which approach would be best for you.

Young female bothered by a dorsal hump and full nasal tip. Most patients look best if the tip is the highest part of the nose from the profile view. In this patient operated on by Dr. Juris Bunkis with the closed technique, the dorsum was brought down to make the tip the highest point on the profile view, the tip was thinned, and a small piece of cartilage placed over the nasal spine to raise the tip, to increase nostril show on the anterior view. These small subtle changes made a big difference in how this patient felt about her appearance.

This young female of Indian extraction was also had a closed rhinoplasty by Dr. Bunkis. The goal, tip the highest part of the profile, etc. are the same as in previous photo set. In situations with “ethnic noses”, it is particularly important not to overdo the correction and to destroy the patient’s ethnicity

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