My son's nose has a bump (which he doesn't mind). He doesn't like that the hump protrudes on each side, and the front hangs down slightly. He would like the sides to be smooth, to keep the bump, and to lift what is hanging down. He has seen two doctors, one who does closed and one open rhinoplasty. The one who does the open says it is easier for him to see to leave what we want on the bridge. Both say he needs the whole thing done for balance- if they just shave the sides it will look wide.
Which is Better- Open or Closed Rhinoplasty?
Doctor Answers (3)
Closed rhinoplasty is preferred
Closed rhinoplasty is the preferred technique for simple straightforward rhinoplasty. A very complicated revision nasal surgery that requires extensive cartilage grafting could be performed with an open rhinoplasty technique. It is very important that you find a rhinoplasty surgeon who has performed thousands of nasal surgeries, and you look extensively at the before-and-after photos that the surgeon has performed. After the bump has been shaved down, the patient will most likely need their nasal sidewalls reset with osteotomies so that the person does not have a square-top nose or an open roof deformity. The whole nose has to be balanced to look proportional.
Rhinoplasty Approach Less Important Than Surgeon's Skill Level
For the nose to be attractive and appear natural, it must be adhere to some basic proportions and be in balance with the other facial features. It is possible to leave a hump and still have the nose be attractive assuming that everything else is in proportion.
The approach - open versus closed - is less important than your surgeons experience and comfort level with the techniques. There are advantages to both the open and closed technique. Choose a surgeon that can provide you with examples of his or her before and after results to look at and a surgeon who you feel understands your/your son's goals and desires for surgery.
Open vs closed rhinoplasty
First of all, your son may not be ready for a rhinoplasty because even though it is the goal to honor a patient's desires, what he is wanting isn't realistic. Dorsal hump reduction and tip rotation should be done if he is going to go through the surgery. Conservatively and properly done, he will be happy later he did it.
Open and closed rhinoplasty each have their advocates. I personally prefer most of the time to do the surgery open. If I were going to work in a room, I would rather do it with the door wide open than through the keyhole. I can be more precise and I can provide more structural integrity with sutures so the result will stand the test of time.