What is a closed rhinoplasty?

Rhinoplasty has been categorized into two main techniques: Closed and Open.

Closed Rhinoplasty

In the most basic sense closed Rhinoplasty (also referred to as minimal incision or incisionless) uses only hidden incisions inside the nose. Most, but not all ,surgical techniques are possible with this approach. It is the oldest of the two techniques, dating back over 50 years.

Open Rhinoplasty

Open Rhinoplasty means that a small incision is made at the base of the nose in the columella. This is the area that separates the two nostrils from each other. As a result, less incisions are made on the inside of the nose. Although this cut usually heals extremely well and can not be seen easily, there are times when the scar is visible. This technique has been around for a long time as well; about 30 years.

Choosing between Closed and Open Rhinoplasty Techniques

The choice between these two techniqes, for me, rests in how much grafting is needed in a particular patient. Because open rhinoplasty gives the surgeon increased visualization of the underlying nasal structures, it is often easier to place grafts and permanent sutures in order to restructure the nose. This can be a blessing if the nose requires extensive work with multiple grafts, such as in revision cases, or, for some surgeons, extreme nasal deviation.

However, this increased exposure does come at a certain price. Besides the potential for a visible incision, there is often increased swelling of the nasal tip and, potentially, an increase in the risk of long term skin changes.

I use predominantly closed rhinoplasty techniques (over 95%) for primary surgeries, deviated nose correction, and selected revision cases. I try to use as few grafts as possible, as they ultimately increase the complication rate. More importantly, I find that my results are more natural with this approach. The operation tends to focus on remodeling the nose, rather than restructuring it.

With all this in mind, the exact same operation and outcome can be achieved with either of these techniques. Each surgeon has a particular preference, based on comfort and experience, for using one technique versus another. In the end, if you like a surgeon's results and feel comfortable with him or her, then you will most likely be happy with the outcome of either technique.