DO you think you can achieve a more defined and refined tip using an open approach verses closed?

Open versus closed rhinoplasty is a question based on the training of your surgeon.  I perform an open technique and feel that it is much easier to make detailed, fine changes to the tip when you can see everything you are working on.  However, this is an opinion, and many skilled surgeons also perform closed rhinoplasty.  Good luck and be safe.John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon

Thank you for your question.  Both techniques can result in excellent tip refinement.  Different surgeons have varying degrees of experience with each technique, and that is what is most important:  finding a plastic surgeon that you're comfortable with, and whose experience you feel will provide you the results you desire.  Best of luck to you.Ruth Celestin, MD

 I can achieve a refined tip through either approach.  I find that the closed rhinoplasty produces less swelling and a shorter recovery.  There is also no visible scar. Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Great question: The technique really depends on the surgeon and what needs to be changed surgically.  One is not better than the other, there are advantages and disadvantages.  Essentially, if skeletal work needs to be done, a closed may be appropriate, if more refinement than an open.  An expert surgeon can advise you for your nose.

The open versus closed technique is only the approach to get inside the nose, not the actual procedure itself. Suture techniques to the lower lateral cartilages and sometimes a conservative cartilage removal are necessary to obtain a refinement of the nasal tip

Excellent cosmetic results can be achieved
with both techniques. There is not a best way to perform the procedure.
Individual surgeons have their own preferences of how to produce the best
results in their hands. What is more important than whether a closed or open
approach is utilized is the experience and artistry of the plastic surgeon and
your comfort level and confidence in that individual.

Following the advice from a surgeon on
this or any other website who proposes to tell you exactly what to do based on
limited 2 dimensional photos without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of the operative procedure would not be in your
best interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) through the Smart Beauty Guide that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California