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Difference Between Closed and Open Rhinoplasty?

What is the difference between closed and open Rhinoplasty. How do you know which is right for you? Thank you.

Doctor Answers 22

Open Versus Closed Rhinoplasty-Open Allows More Detailed Refinement Of Tip

Thank you for your question.

The main difference between Open and Closed Rhinoplasty is that a small incision is made on the underside of the nose-the Columella during an open approach.

This incision is usually well hidden and only seen if you lift your head back so someone can see the underside of your nos.

The skill of your surgeon is the most important factor in achieving a good result.

That said, the surgeon is able to see and more accurately modify the nasal structures through the open approach.

I find that the open approach, in my hands, is the best for achieving a detailed refinement of the nasal tip.

There are however surgeons who achieve excellent results using the older closed approach.

Open Versus Closed 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.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 116 reviews

Closed rhinoplasty and open rhinoplasty

The difference between a closed and open rhinoplasty is simply the external columellar incision. The incision itself will be noticeable for several months after the surgery, and the nose will take longer to heal because of the lymphatic drainage that must re-channelize. The nose will stay swollen for a longer period of time after an open rhinoplasty versus a closed rhinoplasty. The incisions for the closed rhinoplasty are completely identical to the open with the exception of the incision across the columella. The only difference is surgeon preference, and excellent results can be obtained through both closed and open rhinoplasty. Open rhinoplasty is good for a second or third revision whereby extensive scar tissue and cartilage grafting techniques are necessary, and external exposure is needed. A simple primary reduction rhinoplasty is best done closed.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Differences of Closed vs. Open Rhinoplasty

The biggest difference between the open and closed rhinoplasty is a small incision on the columella (bottom) of the nose. This 6 mm incision allows the surgeon to peel the skin of the lower nose back to fully visualize the tip and dorsum of the nose. In the closed procedure, there is not as much visualization since the skin is not peeled back. I use the open approach for any rhinoplasty that needs extensive tip or dorsal work. If the patient, just has a slight dorsal hump, I would then choose the closed approach. It is important for you to let your experienced rhinoplasty surgeon to examine you first to make a recommendation on which type of rhinoplasty would best suit your needs.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.5 out of 5 stars 43 reviews

Difference Between Closed and Open Rhinoplasty

Thanks for your inquiry. Closed rhinoplasty is when nose surgery is performed so that all the surgical incisions are hidden within the nostrils. Open rhinoplasty is when the cosmetic surgeon creates an incision at the bottom of the columella (in between the nostrils) and performs the rhinoplasty by opening up that area. An experienced facial plastic surgeon should assess each patient’s needs individually and recommend the best approach to achieve the desired results.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

An open rhinoplasty allows the surgeon to see more of the tip

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.

Open versus Closed Rhinoplasty

Hi there.  In a nutshell, a closed rhinoplasty implies that all incisions are within the nose.  An open rhinoplasty, in addition to intranasal incisions, involves an external incision as well (usually across the columella, at the base of the nose).

Generally speaking, major tip modifications entails an open rhinoplasty.  The soft tissues are elevated to provide direct access to the underlying tip cartilages.  These cartilages are then sculpted and sutured.

I hope this is helpful.  Best wishes.

Dr. Shah

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon
4.0 out of 5 stars 7 reviews

To open or not that is the question

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.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 13 reviews

Open or closed rhinoplasty

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 16 reviews

Open or Closed Rhinoplasty

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

Sam Speron, MD
Chicago Plastic Surgeon

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.