Open Rhinoplasty Vs Closed Tip-plasty for Subtle Nose Correction?

Question

I need Rhinoplasty to fix the asymmetry in my nostrils. I went to the two "best" surgeons in the area.The first said I would need Open Rhinoplasty. He also said it was over-projected and the crookedness was not noticeable. He seemed more thorough. The second surgeon said it was minor and he could fix it with closed tip plasty. He said it had good projection and would need a small graft. The computer imagery looked good and I liked what the second surgeon said but how do I know which surgeon is correct? I want it to be very subtle and natural.

Houtan Chaboki, MD · Answer

Sasha123,
Either surgical approach may achieve excellent results. Both rhinoplasty methods (open or endonasal/closed) may produce subtle & natural results. Rhinoplasty surgery is not one operation, but rather millions of operations. Results may be variable, even in the best of hands. Only after a comprehensive in-person evaluation can a rhinoplasty surgeon provide his/her best advice for you. Continue doing your research, and best of luck.

Deepak Raj Dugar, MD · Answer

Hello,If you are a primary nose with no previous surgery, you should ONLY consider closed scarless rhinoplasty (preferred by actresses and celebrities) because there is no risk of external scarring and much less healing and recovery time.  The goal is to finesse and enhance the nose without drastic change.  Meaningful refinement is the key.   All the same surgical maneuvers your nose requires can be performed with a skilled closed scarless surgeon.  Seek counsel with a board certified plastic surgeon who performs closed scarless rhinoplasty as 100% of his surgical practice so you know you can guarantee the expertise.  (aka don't get your nose done by a breast surgeon or a facelift surgeon).  Doing your nose the first time with the right surgeon is the key to avoid a botched or revision surgery in the future.  All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

William Portuese, MD · Answer

It is always advisable to have a closed rhinoplasty rather than an open rhinoplasty because of the healing and swelling. If the correction is only very subtle, it may be advisable not to perform any rhinoplasty whatsoever. Asymmetry in the nostrils can be quite difficult to correct.

Peter A. Aldea, MD · Answer

I completely agree with the previous posting. Great surgeons have produced great results with both techniques so I would go with whichever surgeon you feel most comfortable with.
Nostril asymmetry is a nonspecific term which can be applies to alar asymmetry as well as nasal tip asymmetry. Without SEEING what asymmetry you are referring to it is impossible to comment on what may be called for.
What makes me somewhat uncomfortable is that you have two differing opinions on how your nose looks . Surgeon 1 who "seemed more thorough" said your tip "was over-projected and the crookedness was not noticeable" in contrast to surgeon 2's "said it had good projection and would need a small graft". The nasal tip cannot be BOTH normally stationed or over projecting (unless someone is either super critical or nonobservant).
Personally, these days, many surgeons are of the school that cartilage tip grafts should largely be used in secondary nose operations AFTER other less invasive and distorting methods such as suture shaping of the lower lateral cartilages of the nose have been used. This is especially valid if the nasal septum is not going to be otherwise worked on in the course of the operation.
You MAY want to see a third surgeon to see what he/she recommends.
Good Luck.

Robert Kotler, MD, FACS · Answer

More important than the route into the nose is the talent of the surgeon. The clues to the doctor's ability comes from how much experience he has, how specialized the practice is and how other similar cases turned out.
You need to study a large number of the doctor's before and after photos. Ask how long the doctor has performing rhinoplasties and how many he does each year. What percentage of the practice is rhinoplasty?
The answers will guide you to the superspecialist doctor with whom you should consult. 
Don't get hung up on technical details. In cosmetic surgery, the only thing that counts are results!

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question. Refinement of the Nasal Tip or Tip Rhinoplasty requires a detailed view of the3 tip structures. This is possible only, in my opinion, with an Open Rhinoplasty approach. Direct vision of the tip structures and detailed modification using cartilage grafts is required for the best result.

Francis R. Palmer, III, MD (retired) · Answer

I have performed both Open and Closed Rhinoplasty for over 20 years and each technique has it's strengths and weaknesses.  If your nasal tip is asymmetric and you're looking to make the nostrils more symmetric, an Open Rhinoplasty is more likely to accomplish both of these goals than a Closed Rhinoplasty IMO. 

	 The nasal tip cartilages contribute to the shape and support of the nostrils.  An Open Rhinoplasty allows the plastic and cosmetic surgeon the ability to re-shape and suture the tip cartilages directly which a Closed Rhinoplasty or Tip Plasty can't. 

	 In a Closed Rhinoplasty the nasal tip cartilages are delivered through one nostril and while they can be re-shaped they can't be re-shaped in their exact ,midline or middle position like they can during an Open Rhinoplasty...and that in a nutshell is the main difference beytween the open and closed technique IMO. 

	 The only limiting factor, IMHO, for performing an Open Rhinoplasty is the mere fact that by opening up the nose, the nasl tip will be rotated 5 degrees.  So, if your nasal tip is already roated at 110 degrees or more, you should not have an Open Rhinoplasty as this amy cause the nasl tip to appear over-roated and to short which is quite difficult ot correct.

Richard W. Fleming, MD (retired) · Answer

First of all, you apparently have done your homework and had consultations with two of the "best" surgeons in your area. Now you have to decide who is the best . Most experienced surgeons use both the open and closed techniques. In the right hands you will get a good result regardless of the surgical approach. Pick the surgeon, not the technique.

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