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Limitations of Closed Rhinoplasty?

asked 2 years ago by ricardo88 in London
Latest answer by Ryan Greene, MD, PhD
Question viewed 975 times
Tags: nose, tip

What are the main limitations of closed rhinoplasty? And how much work can be done on the tip in closed rhinoplasty, if any?

17 answers to Limitations of Closed Rhinoplasty?

Open vs Closed Rhinoplasty

The limitation of closed rhinoplasty really depends on the surgeon doing the procedure. I have been a strong advocate of the open approach for many nasal problems for many years. However, I still use both techniques. Many respected surgeons never do an open rhinoplasty . Choosing a surgeon is much more important than choosing a technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

No limitations with closed rhinoplasty

There are no limitations with a closed rhinoplasty. All of the surgical techniques that are performed through an open rhinoplasty can be performed through a closed rhinoplasty. The only difference is not having to make the incision across the columella.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

No limitations with endonasal rhinoplasty

While to many surgeons this is still a hot debate, in my opinion, this is an old, boring topic. The majority of experienced rhinoplasty surgeons understand that there are merits to both the external and endonasal approaches. There are really no limitations with either approach; rather, surgeons just happen to be comfortable with one approach over the other. While I personally prefer the external approach, I appreciate the face that endonasal (sometimes called closed) approach is an... more

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon

Closed vs Open Rhinoplasty

My preferred approach is a closed rhinoplasty. Critics of this approach say that it is more difficult to perform complex maneuvers of the tip of the nose. They also feel that it is more difficult to work on the septum using this approach. I have a lot of experience using the closed approach for complex tip and septum work. I personally feel that there is nothing that can't be done using a closed approach. However, I recognize that some surgeons feel that the open approach is better. I think... more

John Diaz, MD
Beverly Hills Plastic Surgeon

Depends on the surgeon's skill and judgement

The debate over which approach is best rages on, but in the end it depends on the skill and judgement of the surgeon, his experience, and proper assessment of the patient's deformities, strength of cartilages, skin thickness, and other factors. The external or open approach is often better for revision cases, complex tip deformities, cleft rhinoplasty, and for saddle nose deformities, as well as cases requiring precise cartilage grafts, in my experience of over 29 years of practice. more

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon

www.specialface.com

Open vs. Closed Rhinoplasty

The surgical approach for any rhinoplasty is individualized. A closed rhinoplasty is usually a reduction rhinoplasty, meaning that portions of cartilage and bone are usually removed. This can be a very acceptable approach for many tip problems. However if extensive suturing of the cartilage is needed then an open approach may be beneficial.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon

Closed rhinoplasty limitations

The limitations of closed rhinoplasty are the lack of the extensive exposure that you have when performing an open rhinoplasty. When a rhinoplasty is particularly complex or requires many grafts, it may be more difficult to achieve with a small incision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Most people only need closed rhinoplasty.

Hi! I think it's all about the experience of the surgeon. Open rhinoplasty is easier because you can see the cartilages. But it is really more surgery than most people need. I do closed rhinoplasty (including refining the tip) on most patients.

George J. Beraka, MD
Manhattan Plastic Surgeon

It depends on the surgeon and the extent of the surgery.

We have been doing open rhinoplasty for more than 30 years. In those days we were called heretics! Today, almost all rhinoplasty surgeons do open rhinoplasty on many of their patients. But there are some noses I still do closed. It depends on many factors. You should choose an experienced rhinoplasty surgeon who does natural looking noses that you like. Then let him guide you as to which is for you.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

Closed versus open rhinoplasty

A closed rhinoplasty has been a long standing approach to nasal surgery. I personally find open rhinoplasty a bit more precise in treating complex septal deviations, and tip problems. A straightforward dorsal hump reduction with limited tip work can be done closed.

Steven Wallach, MD
Manhattan Plastic Surgeon

Rhinoplasty, Limitations of Open versus Closed

Hi Ricardo, Open and closed are approaches to performing the rhinoplasty operation. I agree with both Dr. Waldman and Dr. Pearlman that excellent results can be achieved with both approaches. Dr. Rollin Daniel, a very well respected Newport Beach rhinoplasty specialist takes it one step further and performs a "closed to open" rhinoplasty. Personally I find it easier to secure cartilage grafts with the open approach. Choose your rhinoplasty surgeon based on results, skill,... more

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Closed rhinoplasty options

Limited tip work and slight reduction in the "dorsal hump" region of the nose can be done via a closed approach. More extensive tip work and significant reduction in the height of the nose usually requires the open approach. Both can be done as an outpatient and are pretty well tolerated. Good luck!

Jeffrey E. Schreiber, MD
Baltimore Plastic Surgeon

Closed vs Open Approach for Rhinoplasty

For some surgeons, this topic is like religion. I do about 60% open and 40% closed. Some have strong views that one approach is superior compared to the other. Some surgeons get excellent results using the open (external) and others get equally excellent results using a closed (endonasal approach. So as a patient, the most important thing is to assess your surgeons credentials, experience, and the before and afters. If you like the "look," they achieve on a consistent basis, then... more

Amir M. Karam, MD
San Diego Facial Plastic Surgeon

www.drkaram.com

Limitations of closed rhinoplasty

Dear Ricardo88, The "closed" rhinoplasty long predates the "open" techniques. Some of the legendary rhinoplasty surgeons which in the interest of brevity I will not name were masters of the closed techniques. That being said, if the closed technique was perfect and allowed everything to be done with equal easy and precision it would NOT have given rise to the open techniques. The open techniques offer unrivaled undistorted visibility of the entire nose and its components... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Respectfully Disagree with My Friend and Colleague

There are really two approaches to Rhinoplasty with several hybrid offshoots. One approach is the Open Approach or External Rhinoplasty and the other is the Closed Approach or Endonasal Rhinoplasty. The major difference involves a 5 mm incision across the columella or portion of the nose that separates the two nostrils when performing the external Rhinoplasty. I have now done over 2000 Rhinoplasties using this technique following my training with the "father of this operation"... more

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon

Closed Rhinoplasty Works Great on Tip as Well

The nasal tip can be modified, shaped and contoured very well with closed rhinoplasty. In fact it has an advantage over the open rhinoplasty because the tip swelling after surgery is less with the closed rhinoplasty. The only time an open rhinoplasty is preferred is in revision rhinoplasty where the scarring might be extensive. Ask your surgeon what she or he is comfortable with instead of focusing on what approach to use i.e., closed vs open Regards

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon

Closed rhinoplasty yields equal if not superior results

Surgeons experienced with closed, or endonasal rhinoplasty, can get equal if not superior results to open rhinoplasty for most primary conditions. There is less de-construction of the nasal elements. Also, results can be checked during the procedure. I perform endonasal rhinoplasty for approximately 90% of my primary rhinoplasties and feel that my results are comparable to any open approach. It is more important to go to a surgeon who is a rhinoplasty expert and understands the nuances of... more