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Closed Vs Open Rhinoplasty

Is closed rhinoplasty better than open rhinoplasty? In some answers to other questions on this site I've seen it mentioned that open rhinoplasty causes more swelling. One of my main concerns is noticeable swelling for a prolonged period after surgery. Apart from that, what are the pros and cons of open vs closed please? Thanks.

Doctor Answers 14

Open vs closed rhinoplasty benefits

Overall, no one approach is the "best". The approach is catered based on what needs to be done. Some surgeons have a preference for one versus the other. The benefits of the open approach are especially seen when performing tip work, treating significantly deviated noses and in revision rhinoplasty.

The pros to the open approach are:

  • More complete exposure especially of the tip
  • More precision in technique and control over the ultimate outcome

Some of the cons include:

  • More prolonged nasal edema and numbness
  • A small external incision on the columella. This normally heals very well and is rarely an issue.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Rhinoplasty, Nose syrgery

You are right, open rhinoplasty causes more and longer lasting swelling and also leaves external scras, even though they may not be very obvious. Take longer to perform in the operating room and is overdone especially by less experienced surgeons. There is a temptation to do "more" rather than "enough because of direct access to the anatomical stuctures. I do open rhinoplasty as the last resort if I could not achieve what I want to do with close technic. 

Fereydoon S. Mahjouri, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 15 reviews

Open versus closed rhinoplasty

The approach is less important than what is done during the surgery. I perform mostly closed but do an occasional case open. What I do in each circumstance is not affected by whether it is open or closed. When doing an open case I do find that I place more sutures and occasionally more grafts than I would in a closed procedure. Does that make a difference in the outcome? Probably. But I only open in cases that require that extra work so there's a reason to support making that decision. 

 

When I do closed cases I am constantly able to see what the nose will look like since the skin is in place. Each maneuver gives an immediate change that I can assess. In open that is not the case. 

 

There is a little more tip swelling in open cases that lasts about an extra month. The incision rarely if never is visible. So there's limited downside. Nothing worth accepting a worse result for. But again, for me, there's a reason to make that change in approach.

 

I like to basically resculpt the nose rather then reconstruct it. Modifying the original form into something more refined typically allows for results where the patient still looks like themself. I also think that a more natural result comes from that resculpting approach. That is why I prefer closed technique. 

 

If profile-plasty alone is being done, then I personally think there is no role for open technique. Why manipulate the tip for access if you aren't planning to refine it surgically?

 

I you like a particular surgeon's work then it really doesn't matter how they approach it. It's what's under the skin that counts. 

 

Best of luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

In my practice, Rhinoplasty Surgery is performed with an external or open approach.

My Rhinoplasty teacher taught me the art of nasoseptal reconstruction using the external approach, and this has led to predictable, favorable results. In the majority of my rhinoplasty patients, there is minimal downtime, and normal social activities are typically resumed 8-10 days post-op: shortly after the dressing is removed.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
5.0 out of 5 stars 311 reviews

Closed vs Open Rhinoplasty

Almost all experienced surgeons do both open and closed rhinoplasties.We all have our indidcations for the open which include a revision rhinoplasty, a crooked nose, a nose that requires a lot of tip work, and a nose that requires grafting for augmentation or reconstruction. The relatively short duration of the increased swelling is worth it when the rhinoplasty is difficult because the results are more predictable.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Endonasal vs. External Rhinoplasty - Which is better?

This is a very common question. Many procedures can be performed by either technique. However, in my experience rhinoplasty requiring extensive tip work or revision of a previous surgery are best performed with an external approach. You will be best served by choosing the surgeon and their preferred technique to give you the results that you need. If you require an external rhinoplasty, the increased swelling is only temporary. If the external technique is required to achieve your goal, you will not be that troubled by the temporary swelling. It is obviously the end result that is most important and the swelling will, in time, resolve.

Thank you for your question.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 72 reviews

Closed Vs Open Rhinoplasty

 I agree..choose your Rhinoplasty Surgeon based on his/her understanding and ability to follow the proper aesthetics of facial (and nasal) beauty for the creation of a naturally, more attractive nose and face...not on whether they do open or closed Rhinoplasty because most experienced Rhinoplasty Surgeons use both at the drop of a hat.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Open vs Closed Rhinoplasty

Hi,

This answer to this question depends on who you talk to. Surgeon that do open will tell you open is the best and vica versa. Its good to know both techniques and treat every patient uniquely. I perform most rhinoplasties open because I can see exactly what Im doing to the cartilage, bone and soft tissue. I dont think there is more swelling, because if the open is performed right, most of the surgery is performed in an avascular plane.  In closed, much of the procedure is done blindly. Thats ok if your just removing a bony hump but if any tip work or reconstruction needs to be done then open is the way to go. See my link for an extensive explanation.

Best,

Dr.S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 227 reviews

Closed vs. Open

The minor drawbacks of open rhinoplasty are:

  • More swelling
  • More numbness
  • An external incision in between the nostrils (which typically heals very well)

There are a number of major advantages to the open technique:

  • Superior exposure
  • Precision in technique
  • Better control of the outcome
  • Use of techniques that are not possible with the closed approach

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 165 reviews

Open versus closed rhinoplasty - advantages, disadvantages and reasons

Your question of a closed vs an open approach requires a lengthy answer that is too long to fully cover here. Suffice it to say that it is the result that is important and not necessarily the approach. The open technique does, in general, allow for a more precise and predictable outcome with a lot more flexibility particularly for a more complex nose. Conversely, if the only things that need to be addressed are a small hump and narrowing the base, a closed approach is far more reasonable; the open approach is "overkill".

Some surgeons obtain far better results with the open approach most of the time; others are comfortable and get reasonable results with the closed. Personally, I prefer the open approach in a majority of my rhinoplasties.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

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.