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Open or Closed Rhinoplasty?

I went to a consultation with Dr. Graper in Charlotte, NC and he did some imaging on the computer to let me see how my nose should look once the procedure is done. I'd like to get some feedback, should this be an open or closed Rhinoplasty? Thank you!

Doctor Answers (18)

Open vs. Closed Rhinoplasty

+2

Great question! Interestingly, this question separates rhinoplasty surgeons into one of three camps: those who only perform open rhinoplasty, those who only do endonasal (closed) rhinoplasty, and those who perform both. Ultimately, your surgeon is in the best position to decide, with you, which approach will give the best result in their hands.

Generally speaking, I will use the endonasal (closed) approach whenever it is appropriate to do so. I believe this approach is the “minimally invasive” technique, as it avoids a scar at the bottom of the nose, and is less disruptive of the various support structures inside the nose. I would argue that it is easier to get a picture of what the final result for the nose will look like because the endonasal approach is less traumatic. So every minute refinement I make during the surgery is easily visible from the outside and adjustments can be made right then and there on the operating room table. It also tends to be a shorter duration procedure, which means less anesthesia for the patient, and an easier recovery, with less swelling and bruising during the postoperative period.

In my hands, the following type of nose is best-suited to endonasal (closed) approach: has not had a previous rhinoplasty, mild to moderate dorsal irregularity (e.g. large hump), straightforward tip refinement, and mild to moderate septal deformity.

I prefer open-approach rhinoplasty in those cases where I feel it is important to make significant changes to the underlying framework of the nose, and when I intend to use multiple cartilage grafts. Typically these are for revision rhinoplasty, significant functional issues (e.g. can’t breathe), post-traumatic rhinoplasty, significant nasal septal deviation, or major tip work.

The main message is that rhinoplasty is not a cookie-cutter operation. You want to have your operation done by a surgeon who is comfortable with both the open and closed approaches, and can advise you on which is the best approach for you (and why). Together, you and your surgeon should decide on which approach will provide you with the best result. Good luck!


Toronto Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Closed rhinoplasty

+2

You need to ask your surgeon what technique he or she is comfortable performing.   Surgeon's experience is more important than the technique used.   My preference is the  closed approach especially for primary (first time) rhinoplasty patients. 

Vladimir Grigoryants, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 105 reviews

Rhinoplasty Surgery: Open vs. Closed Rhinoplasty

+2

How do you know which approach is "best" for you? While you may have a preference for one or the other, your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon.

Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs. Trust your surgeon to choose the technique that is best for you.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 91 reviews

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Open or closed--the surgeon is the key to a good result

+2

First of all, forget the imaging. Look at the kind of long-term results he's had with other patients--real people not computer patients.
We pioneered the open technique more than thirty years ago. It gives the surgeon an excellent ability to see what he's doing. However, really good nasal surgeons can achieve good results with either method. More importantly, they know when to use each!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Open Versus Closed Rhinoplasty...It's Not the Approach, It's Who Is Doing the "Approaching"

+2

Hi Adam,

From the picture and computer image it is difficult to answer what is the best approach to your rhinoplasty. After examining the nose, diagnosing what is causing the areas of complaint, and making a plan to correct those complaints, the approach be it open (external) or closed (internal) can better be chosen.

In general, if your tip needs increased support, or upward rotation, or a great deal of work, then I prefer the open approach. Otherwise I perform a closed approach.

Excellent and experienced rhinoplasty surgeons can achieve great results with either approach. Dr. Graper, having examined you, is in the best position to decide the best approach to your nose. If you have any doubts, it doesn't hurt to get a second opinion. I usually encourage my patients to get as many opinions as they need until they feel comfortable.

Be well and happy holidays.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

It does not matter

+2

The pictures look like a reasonable expectation from rhinoplasty. The success of the surgery depends more on the experience and skill of the physician than the choice of open vs. closed. Both procedures work well to reduce a dorsal hump. I prefer the open approach because I can see the entire anatomy, but there are plenty of surgeons who perform only closed procedures with great success. Make sure the surgeon does perform rhinoplasty often as this is a procedure that requires knowledge, experience and can be unforgiving.

Best wishes,

Dr. Ahn

www.awcenter.com

Min S. Ahn, MD
Westborough Facial Plastic Surgeon
4.5 out of 5 stars 22 reviews

Closed versus Open Rhinoplasty

+1
Both open and closed rhinoplasty can give good result. Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs. Your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon.

Colin Hong, MD
Toronto Plastic Surgeon
4.5 out of 5 stars 16 reviews

Open vs closed will depend on prefence of the plastic surgeon

+1

Hello,

Thank you for the question and the photos.  Whether an open approach or a closed approach is chosen will depend on the plastic surgeon as the results you have shown can be achieved with either technique.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 98 reviews

Open vs. closed rhinoplasty

+1

Thank you for your photos.  It looks like your should be able to get a good result.  The important thing is the surgeon that is doing the procedure.  He/she may have a certain approach that works for them in a given situation.  Interview a few of them.  Look at the before/after photos.  Feel free to discuss the approach with the surgeon.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 9 reviews

Open or closed rhinoplasty

+1

It can be done either way, open or closed.  Nowadays, most plastic surgeons have their own personal preference, based on their experience and training.  I prefer the closed rhinoplasty for almost all cases.  In my opinion, it is simpler, takes less time and involves less swelling.  Unfortunately, many surgeons are taught only one way to do rhinoplasty. If they are trained in open rhino, they only know one way to do it, and will tell you it is the best way to go.  Closed rhino has been around 100 years.  It is a shame that many younger surgeons do not know how to do it.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 12 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.