Ask a doctor

Open or Closed for Best Result? (photo)

Hi thanks for the responses from my last post but the surgeons need to see my nose at a different angle. I have had a couple of consultation one said open one said closed i wish to know what would get the best result . I need the hump removed and the tip de-projected. The last pic is a surgeons computer generated result do yo think it is a realistic prospect with closed.

Doctor Answers (9)

Open or closed rhinoplasty

+2

Difference between closed and open rhinoplasty is the approach when performing rhinoplasty. Specific maneuvers performed during rhinoplasty are the same whether it is done through open or closed.  A primary rhinoplasty to file down a nasal hump, osteotomies, and deproject the tip can all be performed quite easily through a closed rhinoplasty.  Look for an experienced surgeon in closed rhinoplasty.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

The skill of the rhinoplasty surgeon is far more important.

+2

Dear “Chris”:

You raise an interesting question concerning the entrance point into the nose to perform rhinoplasty surgery.  As you know, “closed” refers to doing the entire operation through hidden incisions inside the nose.  “Open” rhinoplasty implies that there will be an external incision, which is generally horizontal between the two nostrils.  That incision becomes the main entrance into the nose, although there may be additional internal nasal incisions. 

I just recently attended a seminar at Cedars-Sinai Medical Center here in Los Angeles, and saw some very nice presentations of excellent nasal reconstruction, including rhinoplasty and revision rhinoplasty, done by a variety of surgeons. 

My impression is that the skill of the surgeon is far more important than the route into the nose to perform the surgery.  Many of us have decades of experience performing nasal surgery, and are comfortable with our technique.  Whether it be “open” or “closed” is less important than the judgment and talent of the surgeon.  Based on the photographs you have shared with us, I don’t think it is going to make any difference whether the operation is done open or closed. 

The open technique is relatively new compared to the closed technique.  The original rhinoplasty surgeons performed the closed technique because patients were not anxious to have an external incision.  Some patients are still not anxious to have an external incision.  Frankly, it is rare for the external incision to be highly visible or cause problems, but the decision to have it open or closed should be based on your discussion with the surgeon and your comfort level with the explanation given for the choice.  Remember, the incisions used do not directly determine what specific maneuvers, techniques, or procedures are done during the operation.  The choice of incision is made based on what the surgeon feels will give him a certain exposure and facility to do the procedure. 

I would suggest seeing many before and after rhinoplasty results from the surgeons you are considering.  Look at the results of both closed rhinoplasty and open rhinoplasty, and see if it really makes a difference.  Frankly, I doubt it.  Generally, the incision is far less important than the other technical and operative issues that the surgeon has to encounter to get the result that a patient wants. 

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

Hump

+2

For reduction of over projection, I always do an open tip even though i do %50 of my rhinoplasties closed. Do what your surgeon is best at

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

You might also like...

Open versus closed rhinoplasty

+1

I think that a good rhinoplasty can be performed with either a closed or open approach. I prefer open in most cases to have the best visualization of the structures and to allow for precise tip work.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Open versus closed Rhinoplasty

+1

In the end it doesn't matter how you get there, it's about what you do to the nose. Choose the surgeon, not the approach and you'll be happiest. pick the one with the before and after results you like the best. These results will reflect their specific operating styles. Most surgeons do a combination of open and closed. 

 

Looks like you need a lateral crural overlay which I have done both ways. 

All the best. 

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Closed or Open Rhinoplasty

+1

The changes you would like to make in your nose are realistic and can be done open or closed. The most important decision is to find a Board Certified Plastic Surgeon who does a  lot of Rhinoplasty surgery. Make sure you see lots of photos of that surgeons actual patients. A computer can generate an example of your result, but can that surgeon replicate that? Make sure you like what you see in real patient photos. Whether the surgeon does it open or closed, you want the best result. Best Wishes.

James A. Hoffman, MD
Saint Paul Plastic Surgeon
5.0 out of 5 stars 20 reviews

Closed Rhinoplasty

+1

Although your pictures are not complete it seems that you could benefit from a closed rhinoplasty approach and obtain results similar to the ones created by the computer generated images. You need to have realself expectations since the computer generated pictures are only a simulation !! Good luck

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 80 reviews

Many rhinoplasties can be done closed.

+1

Hi.

You look like you have a pretty easy nose to improve, and you don't need open approach.  I think the projected result is realistic for you.  

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Open vs Closed Rhinoplasty

+1

Your computer generated result is realistic. It makes no difference whether the rhinoplasty is done open or closed. I repeatedly say pick the surgeon, not the technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 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.