More Closed Rhinoplasty Successes Attributable to Doctor's Experience?

The argument over open versus closed rhinoplasty has been going on for several years. One of the best observation one of my colleagues has made is that no matter what level of experience you have, since the open rhinoplasty approach was introduced, surgeons who perform both procedures will tend to favor the open approach when the case is more complex. These cases include nasal valve repair, revision rhinoplasty, and when a great deal of tip work may be necessary.
The closed rhinoplasty approach, although also used in complex cases by some, tends to be used more often in noses that are less complicated. In the end, the choice of approach is not nearly as important as your trust in the surgeon.

When choosing a rhinoplasty surgeon, the MOST important thing is their experience and results. I've seen both fantastic and terrible results from doctors using either open or closed techniques so that does not matter. Doctors are trained a certain way, and that becomes what they are comfortable with, whether open or closed. You should look at the doctors operative experience (doing a rhinoplasty at least every week) and results (a lot of pictures) to decide who will give you a great result.
Good luck,
Dr. Miller

One of the most important factors in the success of your rhinoplasty is your surgeon's experience level. The surgical approach is much less important.
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.
Follow these key points to help you narrow your search for the right doctor for you:
* Research Your Doctors Credentials: Your rhinoplasty surgeon should be Board Certified in either Plastic Surgery or Otolaryngology (Ear, Nose, & Throat Surgery). Not all "cosmetic surgeons" have completed the rigorous training that is required to become Board Certified in either one of these specialities. It is important to find a surgeon who understands both the aesthetic (cosmetic) aspects of nasal surgery as well as the functional aspects.
* Choose a Surgeon Who Specializes in Nasal Surgery: It is important to realize that not all plastic surgeons, nor all ENT surgeons, routinely perform rhinoplasty in their practices. It is imperatice to find one that does. Rhinoplasty takes considerable experience and training to get predictable results. Inquire about what percentage of the doctor's practice is devoted to nasal surgery.
* View the Surgeons Rhinoplasty Before & After Results: Most rhinoplasty surgeons maintain a portfolio of examples of their results that compare before and after photos, and many qualified rhinoplasty surgeons have a "Results Gallery" on their websites. You can tell alot about your potential results by looking to see their previous work.
* Ask to See Simulated Results: Your rhinoplasty surgeon should analyze your pre-operative photographs with you and be able to show you graphically their intended results. Some physicians prefer to use tracing paper to overlay your photographs, while others may show your photos with computer morphing software. Recently, 3D rhinoplasty imaging has become available which allows patients to compare their preop picture with a simulated postop picture and look at them from any angle to see how surgery might change their overall appearance. Gaining a better understanding of what the result would look like before undergoing surgery can help make that decision.
* Trust Your Instincts: Finding a rhinoplasty surgeon who understands your goals, expectations, and desires. Communication is paramount, and you should feel comfortable with your surgeon. Trust your gut.

Yes, it is true that surgeons who perform closed rhinoplasty often have more experience than those who don't. This is an older technique and is more difficult to teach to new surgeons during their training. For this reason, at many teaching institutions, residents are taught the "open" technique, where the resident can actually see what is being done by the senior surgeon. As a result, many younger plastic surgeons have never learned the "closed" technique, or simply feel more comfortable with the open approach.
This does not mean that open rhinoplasty is not a good option for you. A surgeon with experience in both techniques may be better able to advise you and achieve your goals. I would certainly look at the surgeons results and reputation before making a final decision. You definitely want to find someone with a lot of experience and who you feel comfortable with, before you go ahead with surgery.

I would not choose your surgeon on the basis of if they do closed or open. Each technique has it advantages and disadvantages. The technique chosen should be based on your anatomy and what needs to be addressed.
There are some things that open rhinoplasty is better for, and it does not matter how much experience the surgeon has doing the closed.
You just need to choose your surgeon carefully but not solely based on the if they do open or closed.

Your observation is a good one, but don't choose your plastic surgeon solely based on the before and after photos. Rhinoplasty can be done open or closed, as you know, but when a significant amount of work needs to be done open rhinoplasty may be a better choice. Yet, if you are comfortable with your surgeon, you like his/her results (closed or open rhinoplasty), and you know what results you are looking for then you're ready!

The short answer is both approaches are good and in the hands of a skilled and experienced rhinoplasty surgeon, the results should be equal. Having said that, in my practice, I perform about 60% open and 40% closed. My criteria is based on how much work needs to be done on the tip. If significant modification is required then we do it as an open approach. This is simply based on exposure that it takes to build good structure and stable modification of the cartilaginous framework. Web reference for open vs closed rhinoplasty photos: http://www.drkaram.com/photorhino.htm
I hope this helps.
Dr. Amir Karam

Hi Anna,
The simple answer to your question is no. Open or closed is just an approach to rhinoplasty. What determines the results is the rhinoplasty surgeon's skill, experience, attention to detail, and aesthetic sense of beauty and proportions.
Do choose your rhinoplasty surgeon carefully.
Good luck and be well.
Dr. P

The aesthetic results after rhinoplasty have very litte to do with approach (open vs. closed) but with the exact planning and execution of the procedure.
Excellent results can be obtained in almost every nose with either technique. Exceptions to this rule are complex revision rhinoplasty where extensive grafting (often with the use of rib cartilage) are necessary.
But, you will see that certain rhinoplasty surgeons have preferences for one or the other approaches which is a reflection of their own experience and comfort.
The choice for your doctor should not be guided by the surgeon's preferred approach (closed or open) but your comfort with the surgeon and their previous results.

Closed rhinoplasty was the dominant rhinoplasty approach prior to the late 1980's. Therefore, surgeons trained prior to this time are generally more comfortable with endonasal rhinoplasty. The open rhinoplasty approach is used much more commonly these days.
That having been said, there aren't many disadvantages to an open rhinoplasty approach (in the hands of a skilled surgeon) except for a very small scar in the columella (skin bridge between nostrils). The advantages include better exposure and control of the nasal tip cartilages
My decision making process in choosing an approach relates to the amount of work necessary in the nasal tip. There is nothing wrong with either approach.