Difference Between Closed and Open Rhinoplasty?

The question of which surgical approach to rhinoplasty is the "best" -- Open versus Closed -- is one of the most frequently debated topics among Rhinoplasty Specialists. Unfortunately, there is not a simple answer to this question. However, gaining a better understanding of what is involved with each technique and becoming familiar with the advantages and potential disadvantages of each is the first step.
Rhinoplasty is accomplished by removing excess bone and cartilage from beneath the skin covering the nose. In some cases, cartilage grafts are added to help reshape and strengthen the nasal framework. After alteration of the supporting structures, the skin is repositioned over the newly shaped framework to give the nose its new appearance. The changes may be subtle or dramatic, depending on the needs of the patient.
Closed Rhinoplasty refers to a nose job that is performed via internal incisions - i.e., there are no external scars. The surgeon makes one or more incisions along the inside of the nose and lifts the skin up from the nasal framework. Once the skin is elevated, the shape of the nose is changed.

Advantages:

Potentially shorter operative time
Less swelling of the tip
No external scar



Open Rhinoplasty, on the other hand, uses the same incisions as a closed rhinoplasty with the addition of an incision on the undersurface of the column of tissue that separates the nostrils called the columella. While this places a small scar on the exterior of the nose, in most cases, the incision heals very well and is not noticable at conversational distances.

Advantages:

Better visualization for the surgeon
Direct exposure of the anatomic structures
More precise intraoperative diagnosis
Less distortion of the nasal framework from intraoperative retraction
Ideal for complex nasal deformities



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.

Hello,In an open rhinoplasty you make an incision at the base of the nose that can inflicts a scar. Most surgeons are more comfortable with the “open” rhinoplasty approach because it is easier for them to personally see the nose. In a closed rhinoplasty approach they make all of the incision 100% on the inside of the nose so no scars are made. If you are a primary nose with no previous surgery, you should ONLY consider closed scarless rhinoplasty (preferred by actresses and celebrities) because there is no risk of external scarring and much less healing and recovery time.  The goal is to finesse and enhance the nose without drastic change.  Meaningful refinement is the key.   All the same surgical maneuvers your nose requires can be performed with a skilled closed scarless surgeon.  All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

Rhinoplasty surgery can be performed through either an open or closed approach. With both of these techniques incisions are made on the inside of the nose along the nostril rim. When a closed approach is utilized no additional incisions are made. The surgeon is able to operate through these nostril incisions but doesn’t have direct visualization of the underlying anatomic structures. In contrast when an open approach is utilized a small incision is mad across the columella that connects the two nostril incisions. This small incision tends to heal nicely and is almost imperceptible in most cases. This approach gives the surgeon the ability to lift the skin off the underlying bone and cartilage and directly visualize these anatomic structures.
                The approach utilized depends upon a variety of factors including the patient’s anatomic findings, aesthetic goals and the surgeon’s preference. Historically, the vast majority of rhinoplasties were performed with a closed technique. This has gradually changed over the years and now most rhinoplasties are performed with an open approach. This is probably due to the fact that surgeons can more easily visualize the underlying anatomy when this approach is utilized.

                It’s important to understand that most surgeons utilize both approaches. Most surgeons agree that the surgical approach utilized is less important than the surgeon’s skill. For this reason, it’s important to consult a board certified rhinoplasty surgeon with experience in this area. 

Open rhinoplasty is a very common technique when the skin is lifted upward like the hood on a car. With the skin lifted upward, the underling framework can be seen directly. This allows changes to be made very precisely. The more complicated the rhinoplasty the more advantageous it is to use an open rhinoplasty technique. That being said there are still very experience rhinoplasty surgeons that can get great results using closed techniques. The best advise would be to choose a surgeon whose results and bedside manner you like best. then allow them to perform the rhinoplasty as they feel most comfortable. Good luck.

Open rhinoplasty is ideal for patients who desire tip modification. Closed rhinoplasty may be appropriate for patients who are just having a hump reduction. An open rhinoplasty gives the surgeon far greater visibility into the nasal anatomy and the freedom to make the desired changes to the tip. The open rhinoplasty incision heals really well and is imperceptible once healed. The video below explains open vs. closed rhinoplasty in great detail.

An open rhinoplasty is where the cut also goes across the columella (the bridge of skin that separates the nostrils). The scar is placed in a way that means it is virtually invisible other than when someone is looking very closely at you. Try drawing a line across this part of your nose (with washable ink!) and look in the mirror. It is surprising how dificult this is to see. In addition to this cut, there will still be cuts inside the nose, running parallel to the borders of the nostrils. A closed rhinoplasty is where only the cuts inside the nose are made. This was originally developed to be used to fix broken noses, where more refined work on the tip is not usually carried out.If you think your tip is absolutely fine, the closed approach might be right for you. If you think you need your tip working on, then the open technique is best (in my opinion).I prefer the open rhinoplasty technique whenever I am operating on the tip. In my opinion this allow much better visualisation of the skeleton of the nose, in particular, the tip of the nose. The tip is a very complex structure and requires sub-millimetre precision. My feeling is that this can only be achieved when the surgeon is able to get a proper look at the tip cartilages. The open approach also allows more precise placement of stitches and grafts to reshape the tip.  Occasionally (although, this is very rare in my practice) I find myself not operating on the tip. In such cases a closed approach can be suitable. However, I almost always find myself thinking that an open approach is best, just in case anything unexpected is found (such as previous trauma to the tip).These days, most surgeons perform open rhinoplasties. The number of surgeons performing closed surgery has been steadily reducing. However, there are some excellent senior surgeons who argue very convincingly that the closed approach is also very good for the tip.Thanks for the question, I hope you find this answer helpful.

Most plastic surgeons do both open or closed approaches depending on the "problem".Open approach uses an incision along the columella that the closed approach doesn't.  While men and women fear an obvious scar, these almost always appear invisible and should not be a real concern.  Open allows more visualization of structures and affords more control and "tricks" for tip work.  Closed approach in my hands are reserved only when I'm taking down a hump.  Open will likely result in longer swelling than closed.Thus, one isn't always better than the other.  It depends on what is being addressed and experience of the plastic surgeon.  Some are even married to one or the other regardless of what they are addressing.

Here is the difference.  Closed rhinoplasty involves working entirely through the nostril.  Open rhinoplasty adds an incision across the columella, the skin between the nostrils.  I prefer the closed method.  It is simpler, takes less time and has less tip swelling.  The most important factor is the skill and experience of the particular surgeon, not which method is used.  Make sure you see lots of the surgeons work and if you are not crazy about their results, keep looking.

Hi,
Thank you for your question.
Open rhinoplasty is used for more major reshaping. External incisions are made on the vertical part of your nose (columella) as well as the inside. The skin and soft tissue are pulled away so the surgeon can see the internal anatomy of the nose.
A closed rhinoplasty is usually for minor reshaping. The incisions are made inside of the nose and the skin is separated from the bone and cartilage. Once this is done, the bone and cartilage can be altered or augmented to reshape the nose.
Which procedure is right for you should be discussed with a board certified plastic surgeon and preferably one that specializes in rhinoplasty. You will be examined, talk about your expectations, and from there you can decide together the best approach for you.
Best regards,
Dr.Speron

This can be argued by both sides, but I perform both the open and the closed. It really depends on the patient and what you are trying to achieve. The open rhinoplasty does give you much better exposure and visualization of the structures. It is also much better approach for patients that require tip work.
Hope that helps answer your question.