During Closed Approach, Will the Scar Tissue Just Develop in the Vestibular Skin?

You are correct.  When using the “closed” endonasal approach, the external incisions are placed along the mucosal surfaces inside of the nose.  Consequently, any visible external scars are also located inside the nose. 

The various steps performed during rhinoplasty, dissection of muscles, soft tissue elevation, cartilage recontouring will also all lead to development of scar tissue.  This internal scar tissue can lead to irregularities which can sometimes be identifiable underneath the skin.    

Of the countless variables encountered during this challenging procedure, unacceptable external scarring is one of the easiest to control.  Even with an open-approach, where incisions are made of the surface of the skin, proper closure should lead to a scar which is virtually imperceptible at speaking distance.  Internal scarring is a challenge confronted in both endonasal and open-approach rhinoplasty, and is much more difficult to predict and treat.

The incisions for the closed approach are the same as an open approach with the only exception being the columellar incision.  With the closed approach there is still undermining of the entire nasal framework just like in the open rhinoplasty.  Scar tissue will develop underneath the entire nasal cartilage and bone where it was undermined.

Hi Ameliabeau;

Closed rhinoplasty implies that all the incisions are made within the nose.  Actual scarring, like a keloid or thick scar, does not exist inside the nose.  Often, what is called "scarring" is actually over-tightening of the cartilage and, therefore, the internal nasal valve becomes narrow.  But, that is not because of scar tissue, per se.  It is generally because too much cartilage was taken out, and the remaining cartilage is drawn together, therefore, diminishing the radius of the internal opening.

If you are trying to decide between having a nose operation "opened" or "closed," I would tell you that decision is less important than the skill, experience, and degree of specialization of the rhinoplasty surgeon.  Many excellent and experienced surgeons can perform the entire operation through the inside of the nose.  On the other hand, many expert, experienced, and specialized surgeons excel at performing it externally, creating a scar that is barely visible. 

The most important thing for you is ifthe overall aims can be achieved.  At consultation, be sure to inquire about computer imaging, so that you can see the predicted result of the procedure as suggested by the surgeon, and achievable by the surgeon.

Robert Kotler, MD, FACS
Facial Plastic Surgeon
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON