My choice for you would be an open approach. This approach allows you to carefully and accurately measure, shape and contour the nasal structures during the surgery. You nasal hump would be reduced, your tips projection decreased and the drooping of the nose corrected. The incision for an open approach is very well hidden after it has healed. A consultation would allow your plastic surgeon to teach you more about how your nasal contour would be improved.
The best approach is what the surgeon is best at. I would do your nose open. Without examining you, of course, it looks like your tip over projects and droops. The hump reduction is just part of it. I think you would be best served through an open approach. Do not worry about the scar. It generally hides very nicely. I have attached a link about ethnic rhinoplasty.
Excellent cosmetic results can be achieved
with both techniques. There is not a best way to perform the procedure.
Individual surgeons have their own preferences of how to produce the best
results in their hands. A closed approach is not "old fashioned." What is more important than whether a closed or open
approach is utilized is the experience and artistry of the plastic surgeon and
your comfort level and confidence in that individual.
Following the advice from a surgeon on
this or any other website who proposes to tell you exactly what to do based on
limited 2 dimensional photos without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of the operative procedure would not be in your
best interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Either method is acceptable. Best to seek a surgeon with excellent befores and afters of each technique of rhinoplasty...
I would not worry so much on the type of approach used, just that the surgeon is comfortable with it. Most surgeons train in one or the other way and usually adopt a preferred method. You can get a great result with either method.
A plastic surgeon skilled at rhinoplasty can perform the procedure either way. It is usually determined on a case by case basis. If grafting and sculpting of the tip is going to be more difficult I perfer an open approach.
debate between facial plastic surgeons regarding which rhinoplasty method- open
or closed- is best has been ongoing for years and will likely continue for many
more. In theory, your specific surgical
goals could be accomplished via either technique. Rather than focus on exactly which technique
your surgeon uses, it is best for you and your surgeon to have an open
discussion about your goals so that the two of you can determine realistic
expectations of a post-surgical result.
This is a question of training and preference. Some surgeons feel better with one approach than the other. I use both approaches but my favorite approach is closed approach. The pros and cons of each approach are discussed and debated by the best surgeons in the world without an agreement.
In summary, go with the surgeon you are most comfortable with instead of deciding based on the rhinoplasty approach.
The only difference between open and closed rhinoplasty is the lack of an incision across the columella with a closed technique. The internal incisions with open and closed rhinoplasty are identical. Through closed rhinoplasty techniques, the tip can be raised and narrowed, the hump shaved down and osteotomies performed. Releasing the depressor septi ligament could also be performed at the same time through closed rhinoplasty. Excellent results can be obtained with either approach. For many examples, please see the link below to our extensive closed rhinoplasty photo gallery
You appear to have a long nose with a dorsal hump and a droopy nasal tip. In order to address your droopy tip, it would need to be reconstructed, and in our practice, an open approach is preferred.
Hope this helps you.