DO you think you can achieve a more defined and refined tip using an open approach verses closed?

Excellent cosmetic results can be achieved
with both techniques. There is not a best way to perform the procedure.
Individual surgeons have their own preferences of how to produce the best
results in their hands. What is more important than whether a closed or open
approach is utilized is the experience and artistry of the plastic surgeon and
your comfort level and confidence in that individual.

Following the advice from a surgeon on
this or any other website who proposes to tell you exactly what to do based on
limited 2 dimensional photos without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of the operative procedure would not be in your
best interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) through the Smart Beauty Guide that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

 I can achieve a refined tip through either approach.  I find that the closed rhinoplasty produces less swelling and a shorter recovery.  There is also no visible scar. Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA