Hi Adam,
From the picture and computer image it is difficult to answer what is the best approach to your rhinoplasty. After examining the nose, diagnosing what is causing the areas of complaint, and making a plan to correct those complaints, the approach be it open (external) or closed (internal) can better be chosen.
In general, if your tip needs increased support, or upward rotation, or a great deal of work, then I prefer the open approach. Otherwise I perform a closed approach.
Excellent and experienced rhinoplasty surgeons can achieve great results with either approach. Dr. Graper, having examined you, is in the best position to decide the best approach to your nose. If you have any doubts, it doesn't hurt to get a second opinion. I usually encourage my patients to get as many opinions as they need until they feel comfortable.
Be well and happy holidays.
Dr. P
