There really is no best approach, surgeons just have their own personal preference as to which way they perform the rhinoplasty procedure. The big difference is that with a closed approach all the incisions are placed inside the nose versus open approach where there is an incision across the columella. For many examples of noses similar to your own, please see our closed rhinoplasty photo Gallery
I prefer in many cases to perform an open rhinoplasty with the incision made at the "waist" of the columella. There are plenty of excellent surgeons that will do them closed as well.
There is no significant difference between open and closed approaches. The only difference is the one incision made on the columella . Each surgeon has her/his preferred approach. What matters most is the results obtained by the surgeon.
An open Rhinoplasty through the upper lip is risky and unnecessary. Most experienced Plastic Surgeons would not do an open Rhinoplasty in this way.
The nose can be accessed for an open rhinoplasty through the upper lip at this requires fairly extensive dissection that in my opinion is unnecessary.
The columella is the most common for open. I use closed for all of my rhinoplasties.
Kenneth Hughes, MD
Los Angeles, CA