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

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

If you are referring to the idea of scar tissue affecting the rhinoplasty result this concept does not necessarily apply to the incision. The rhinoplasty procedure involves separating the skin from the underlying cartilage and bone to reshape it and then having the skin conform to the new shape. It is this skin lifting and dissection that creates the potential for "scar tissue" to affect the result, not the incision itself. Having said that, the use of endonasal incisions only can sometimes allow less dissection to take place and thus decrease the risk of scar tissue issues. Many who use this approach primarily would argue it's superiority because of this.