Open vs. Closed Rhinoplasty: Which One is Right for You?

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The question of which surgical approach to rhinoplasty is the "best" -- Open versus Closed -- is one of the most frequently debated topics among Rhinoplasty Specialists.  Unfortunately, there is not a simple answer to this question. However, gaining a better understanding of what is involved with each technique and becoming familiar with the advantages and potential disadvantages of each is the first step.

Simply stated, rhinoplasty -- or nose job surgery -- is a surgical procedure that involves reshaping the nose. It can be either a cosmetic procedure performed to improve the appearance of the nose, a medically necessary procedure to improve nasal breathing, or a combination of both.

Rhinoplasty is accomplished by removing excess bone and cartilage from beneath the skin covering the nose. In some cases, cartilage grafts are added to help reshape the nasal framework. After alteration of the supporting structures, the skin is repositioned over the newly shaped framework to give the nose its new appearance. The changes may be subtle or dramatic, depending on the needs of the patient.

Closed Rhinoplasty refers to a nose job that is performed via internal incisions - i.e., there are no external scars.  The surgeon makes one or more incisions along the inside of the nose and lifts the skin up from the nasal framework. Once the skin is elevated, the shape of the nose is changed.

  • Advantages:
    • Potentially shorter operative time
    • Less swelling of the tip
    • No external scar

Open Rhinoplasty, on the other hand, uses the same incisions as a closed rhinoplasty with the addition of an incision on the undersurface of the column of tissue that separates the nostrils called the columella. While this places a small scar on the exterior of the nose, in most cases, the incision heals very well and is not noticable at conversational distances.

  • Advantages:
    • Better visualization for the surgeon
    • Direct exposure of the anatomic structures
    • More precise intraoperative diagnosis
    • Less distortion of the nasal framework from intraoperative retraction
    • Ideal for complex nasal deformities

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.

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Dallas Facial Plastic Surgeon