Is closed rhinoplasty safer than opened?

Thank you for your question.  This is commonly asked, and unfortunately, a lot of misinformation exist.First off, the terminology is incorrectly used by many surgeons.  The best way to talk about these approaches is endonasal ("closed") versus external ("open").  The term 'closed' is incorrect because there are, in fact, multiple incisions inside the nose, and in many cases it can be very destructive.   Unfortunately, the term 'closed' is often used as a marketing tool.What is more important is the experience of any given surgeon with any given technique, and the specifics of what is necessary in any given rhinoplasty.  It may be more prudent for surgeon X to perform an endonasal rhinoplasty for a given type of rhinoplasty, while surgeon Y may get safe, effective results using an external technique.  In other words, it is better to focus on actual results from a given surgeon rather than choosing a surgeon base on technique rather than results.Hope this helps you and others with similar questions.Best,Dr. Most

There is a debate amongst surgeons about which approach for nasal surgery is better, an open or closed approach. The difference is a small incision along the base of the columella, which often heals imperceptible. Given the choice of an open or closed approach depends on your surgeon and his/her comfort with each technique, as well as his/her ability to produce the results you desire. Because procedures are customized to each patient, there is no "one size fits all," and the option chosen should be what is best for that particular patient.

Closed rhinoplasty reduces the appearance of visible scar and maintains the blood supply a little better.Kenneth Hughes, MDLos Angeles, CA

When it comes to open vs. closed rhinoplasty neither is necessarily safer or better than the other. I personally use both techniques and base the decision on which method to use on what changes need to be made to the nose. I prefer the open approach when doing tip work as it affords better access to the tip. In skilled hands neither approach is particularly risky. You should base your decision on which surgeon to select to do your surgery on their long term results, not which surgical approach they use. Both the open and closed approaches have a many decades long history safe use when used in the right situations.You can read much more about the open vs. closed rhinoplasty approach at my web reference link below. 

 This depends on how experience the surgeon is. In more than 35 years of doing open and closed rhinoplasty I've never had any infection or serious complication. Choose the surgeon who does natural looking noses and let him choose which she has more expertise with. The most important thing is choosing a surgeon who does natural looking noses.

Dear EdithloveI think there are significant differences between the two methods, however, each has its place. Although at first glance, the difference is just the incision, there are structural and outcome differences that make either procedure better for different goals. Closed rhinoplasty is usually less involved and  has less edema and faster recovery. The surgeon is often more experienced and doesn't need as much exposure to perform needed techniques. Open rhinoplasty gives the surgeon a much more open view of structures,however, more variables and longer edema, longer recovery time. My advice is to let your surgeon choose and recommend the technique. He or she has spent long hours, a lifetime, learning and mastering rhinoplasty. You should focus on communicating your specific goals.  Give your surgeon the destination, he will take you there in the most consistent and  efficient way.

You have touched on an on-going debate.  They are both safe in the right hands and depends upon the training and experience of the surgeon. Think of repairing a watch under a towel by feel and limited visibility compared to good exposure, well lit and with magnifying glasses. Small but disturbing discrepancies often don't reveal themselves in noses for a year or more and open procedures, while more time-demanding, will allow for more accurate repairs

This is a controversial issue but in general a closed rhino will give you less swelling and avoid a scar. Some surgical maneuvers can be difficult to perform from a closed approach and you will have to discuss it with your surgeon as to how comfortable he/she is with performing a closed rhinoplasty.

The choice between a closed vs.open rhinoplasty is not one of safety, rather it is more of an issue of effectiveness based on the nasal problem being treated.

I would not say that one is safer than the other exactly but they do exist as different techniques for different purposes.I think a lot of reductive rhinoplasty can be done through clothes technique very effectively.  Obviously you want to get more than one consultation with experienced rhinoplasty surgeons  andmake your decisions based on that advice.  I'll attach a videoChase Lay, MD