I am choosing a plastic surgeon. By seeing the before and after pictures, I have noticed, that doctors who performed more closed rhinoplasty surgeries have offen also better results. Is it because they have normally more experience?
More Closed Rhinoplasty Successes Attributable to Doctor's Experience?
Doctor Answers (21)
Open versus closed Rhinoplasty
The argument over open versus closed rhinoplasty has been going on for several years. One of the best observation one of my colleagues has made is that no matter what level of experience you have, since the open rhinoplasty approach was introduced, surgeons who perform both procedures will tend to favor the open approach when the case is more complex. These cases include nasal valve repair, revision rhinoplasty, and when a great deal of tip work may be necessary.
The closed rhinoplasty approach, although also used in complex cases by some, tends to be used more often in noses that are less complicated. In the end, the choice of approach is not nearly as important as your trust in the surgeon.
Rhinoplasty Results and Approach
The aesthetic results after rhinoplasty have very litte to do with approach (open vs. closed) but with the exact planning and execution of the procedure.
Excellent results can be obtained in almost every nose with either technique. Exceptions to this rule are complex revision rhinoplasty where extensive grafting (often with the use of rib cartilage) are necessary.
But, you will see that certain rhinoplasty surgeons have preferences for one or the other approaches which is a reflection of their own experience and comfort.
The choice for your doctor should not be guided by the surgeon's preferred approach (closed or open) but your comfort with the surgeon and their previous results.
Open Rhinoplasty is a nasal tip decision
Closed rhinoplasty was the dominant rhinoplasty approach prior to the late 1980's. Therefore, surgeons trained prior to this time are generally more comfortable with endonasal rhinoplasty. The open rhinoplasty approach is used much more commonly these days.
That having been said, there aren't many disadvantages to an open rhinoplasty approach (in the hands of a skilled surgeon) except for a very small scar in the columella (skin bridge between nostrils). The advantages include better exposure and control of the nasal tip cartilages
My decision making process in choosing an approach relates to the amount of work necessary in the nasal tip. There is nothing wrong with either approach.
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Rhinoplasty results may be related to results
Closed rhinoplasty is typically reserved for less complex cases. It is logical that you would get better results in these instances. However open techniques are more commonly employed in more difficult situations where a higher rate of less favorable outcomes is more likely.
Open vs. Closed (Endonasal) Rhinoplasty Results
Closed (endonasal) or open rhinoplasty surgery have their advantages and disadvantages. There isn't a better method or approach that is applicable to all patients.
The plastic surgeon can modify or alter any part of the nose, including the tip and hump with either technique. The exact method of rhinoplasty is based on the plastic surgeon's prior training and expertise, and the requirements of your specific rhinoplasty. Some outstanding rhinoplasty surgeons may utilize one approach, either open or endonasal, for most patients. When deciding on open vs. closed rhinoplasty, one should follow the advice of your plastic surgeon, and your specific rhinoplasty needs.
Rhinoplasty, Beverly Hills Rhinoplasty, Nasal Refinement, Nose Job, Closed
I have performed both open and closed Rhinoplasty for over 20 years and it's the training and experience of the plastic and cosmetic surgeon that's the most important, not whether they do an open or closed. Find a Rhinoplasty Surgeon that you feel comfortable in their aesthetic vision and experience and let them decide whether they want to do your Rhinoplasty open or closed.
Results of open rhinoplasty vs closed rhinoplasty
It is important to choose a facial plastic surgeon that has done thousands of rhinoplasties. Look at many of the surgeon’s before-and-after photos. An experienced surgeon who has done thousands of rhinoplasties can obtain excellent results. Whether the procedure is done as an open rhinoplasty or a closed rhinoplasty is the surgeon and patient’s choice and really should not have any bearing or effect on the eventual outcome. The only difference is that on the open rhinoplasty there is an incision across the columella of the nose, which can be noticeable for several months in the postoperative period.
Results aren't determined by an open or closed approach
When choosing a rhinoplasty surgeon, the MOST important thing is their experience and results. I've seen both fantastic and terrible results from doctors using either open or closed techniques so that does not matter. Doctors are trained a certain way, and that becomes what they are comfortable with, whether open or closed. You should look at the doctors operative experience (doing a rhinoplasty at least every week) and results (a lot of pictures) to decide who will give you a great result.
Open Versus Closed Rhinoplasty -- Surgeon's Experience is More Important
One of the most important factors in the success of your rhinoplasty is your surgeon's experience level. The surgical approach is much less important.
How do you know which approach is "best" for you? While you may have a preference for one or the other, your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon. Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs.
Follow these key points to help you narrow your search for the right doctor for you:
* Research Your Doctors Credentials: Your rhinoplasty surgeon should be Board Certified in either Plastic Surgery or Otolaryngology (Ear, Nose, & Throat Surgery). Not all "cosmetic surgeons" have completed the rigorous training that is required to become Board Certified in either one of these specialities. It is important to find a surgeon who understands both the aesthetic (cosmetic) aspects of nasal surgery as well as the functional aspects.
* Choose a Surgeon Who Specializes in Nasal Surgery: It is important to realize that not all plastic surgeons, nor all ENT surgeons, routinely perform rhinoplasty in their practices. It is imperatice to find one that does. Rhinoplasty takes considerable experience and training to get predictable results. Inquire about what percentage of the doctor's practice is devoted to nasal surgery.
* View the Surgeons Rhinoplasty Before & After Results: Most rhinoplasty surgeons maintain a portfolio of examples of their results that compare before and after photos, and many qualified rhinoplasty surgeons have a "Results Gallery" on their websites. You can tell alot about your potential results by looking to see their previous work.
* Ask to See Simulated Results: Your rhinoplasty surgeon should analyze your pre-operative photographs with you and be able to show you graphically their intended results. Some physicians prefer to use tracing paper to overlay your photographs, while others may show your photos with computer morphing software. Recently, 3D rhinoplasty imaging has become available which allows patients to compare their preop picture with a simulated postop picture and look at them from any angle to see how surgery might change their overall appearance. Gaining a better understanding of what the result would look like before undergoing surgery can help make that decision.
* Trust Your Instincts: Finding a rhinoplasty surgeon who understands your goals, expectations, and desires. Communication is paramount, and you should feel comfortable with your surgeon. Trust your gut.
Surgeons who preform closed rhinoplasty often have more experience
Yes, it is true that surgeons who perform closed rhinoplasty often have more experience than those who don't. This is an older technique and is more difficult to teach to new surgeons during their training. For this reason, at many teaching institutions, residents are taught the "open" technique, where the resident can actually see what is being done by the senior surgeon. As a result, many younger plastic surgeons have never learned the "closed" technique, or simply feel more comfortable with the open approach.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.