Difference Between Closed and Open Rhinoplasty?

What is the difference between closed and open Rhinoplasty. How do you know which is right for you? Thank you.

Doctor Answers 26

Open Versus Closed Rhinoplasty-Open Allows More Detailed Refinement Of Tip

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Thank you for your question.

The main difference between Open and Closed Rhinoplasty is that a small incision is made on the underside of the nose-the Columella during an open approach.

This incision is usually well hidden and only seen if you lift your head back so someone can see the underside of your nos.

The skill of your surgeon is the most important factor in achieving a good result.

That said, the surgeon is able to see and more accurately modify the nasal structures through the open approach.

I find that the open approach, in my hands, is the best for achieving a detailed refinement of the nasal tip.

There are however surgeons who achieve excellent results using the older closed approach.

Open Versus Closed Rhinoplasty

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The question of which surgical approach to rhinoplasty is the "best" -- Open versus Closed -- is one of the most frequently debated topics among Rhinoplasty Specialists. Unfortunately, there is not a simple answer to this question. However, gaining a better understanding of what is involved with each technique and becoming familiar with the advantages and potential disadvantages of each is the first step.

Rhinoplasty is accomplished by removing excess bone and cartilage from beneath the skin covering the nose. In some cases, cartilage grafts are added to help reshape and strengthen the nasal framework. After alteration of the supporting structures, the skin is repositioned over the newly shaped framework to give the nose its new appearance. The changes may be subtle or dramatic, depending on the needs of the patient.

Closed Rhinoplasty refers to a nose job that is performed via internal incisions - i.e., there are no external scars. The surgeon makes one or more incisions along the inside of the nose and lifts the skin up from the nasal framework. Once the skin is elevated, the shape of the nose is changed.

  • Advantages:
    • Potentially shorter operative time
    • Less swelling of the tip
    • No external scar

Open Rhinoplasty, on the other hand, uses the same incisions as a closed rhinoplasty with the addition of an incision on the undersurface of the column of tissue that separates the nostrils called the columella. While this places a small scar on the exterior of the nose, in most cases, the incision heals very well and is not noticable at conversational distances.

  • Advantages:
    • Better visualization for the surgeon
    • Direct exposure of the anatomic structures
    • More precise intraoperative diagnosis
    • Less distortion of the nasal framework from intraoperative retraction
    • Ideal for complex nasal deformities

How do you know which approach is "best" for you? While you may have a preference for one or the other, your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon. Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 149 reviews

Closed rhinoplasty and open rhinoplasty

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The difference between a closed and open rhinoplasty is simply the external columellar incision. The incision itself will be noticeable for several months after the surgery, and the nose will take longer to heal because of the lymphatic drainage that must re-channelize. The nose will stay swollen for a longer period of time after an open rhinoplasty versus a closed rhinoplasty. The incisions for the closed rhinoplasty are completely identical to the open with the exception of the incision across the columella. The only difference is surgeon preference, and excellent results can be obtained through both closed and open rhinoplasty. Open rhinoplasty is good for a second or third revision whereby extensive scar tissue and cartilage grafting techniques are necessary, and external exposure is needed. A simple primary reduction rhinoplasty is best done closed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Differences of Closed vs. Open Rhinoplasty

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The biggest difference between the open and closed rhinoplasty is a small incision on the columella (bottom) of the nose. This 6 mm incision allows the surgeon to peel the skin of the lower nose back to fully visualize the tip and dorsum of the nose. In the closed procedure, there is not as much visualization since the skin is not peeled back. I use the open approach for any rhinoplasty that needs extensive tip or dorsal work. If the patient, just has a slight dorsal hump, I would then choose the closed approach. It is important for you to let your experienced rhinoplasty surgeon to examine you first to make a recommendation on which type of rhinoplasty would best suit your needs.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.8 out of 5 stars 67 reviews

Is open or closed rhinoplasty better?

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Open rhinoplasty is ideal for patients who desire tip modification. Closed rhinoplasty may be appropriate for patients who are just having a hump reduction. An open rhinoplasty gives the surgeon far greater visibility into the nasal anatomy and the freedom to make the desired changes to the tip. The open rhinoplasty incision heals really well and is imperceptible once healed. The video below explains open vs. closed rhinoplasty in great detail.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Difference between Open and Closed

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In an open rhinoplasty you make an incision at the base of the nose that can inflicts a scar. Most surgeons are more comfortable with the “open” rhinoplasty approach because it is easier for them to personally see the nose. In a closed rhinoplasty approach they make all of the incision 100% on the inside of the nose so no scars are made. 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.  

All the best, 

Deepak Dugar, MD
Scarless Rhinoplasty Expert
Beverly Hills, CA 90210

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews

Open Versus Closed Rhinoplasty

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Rhinoplasty surgery can be performed through either an open or closed approach. With both of these techniques incisions are made on the inside of the nose along the nostril rim. When a closed approach is utilized no additional incisions are made. The surgeon is able to operate through these nostril incisions but doesn’t have direct visualization of the underlying anatomic structures. In contrast when an open approach is utilized a small incision is mad across the columella that connects the two nostril incisions. This small incision tends to heal nicely and is almost imperceptible in most cases. This approach gives the surgeon the ability to lift the skin off the underlying bone and cartilage and directly visualize these anatomic structures.

                The approach utilized depends upon a variety of factors including the patient’s anatomic findings, aesthetic goals and the surgeon’s preference. Historically, the vast majority of rhinoplasties were performed with a closed technique. This has gradually changed over the years and now most rhinoplasties are performed with an open approach. This is probably due to the fact that surgeons can more easily visualize the underlying anatomy when this approach is utilized.

                It’s important to understand that most surgeons utilize both approaches. Most surgeons agree that the surgical approach utilized is less important than the surgeon’s skill. For this reason, it’s important to consult a board certified rhinoplasty surgeon with experience in this area. 

Open rhinoplasty

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Open rhinoplasty is a very common technique when the skin is lifted upward like the hood on a car. With the skin lifted upward, the underling framework can be seen directly. This allows changes to be made very precisely. The more complicated the rhinoplasty the more advantageous it is to use an open rhinoplasty technique. That being said there are still very experience rhinoplasty surgeons that can get great results using closed techniques. The best advise would be to choose a surgeon whose results and bedside manner you like best. then allow them to perform the rhinoplasty as they feel most comfortable. Good luck.

Difference Between Closed and Open Rhinoplasty

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Thanks for your inquiry. Closed rhinoplasty is when nose surgery is performed so that all the surgical incisions are hidden within the nostrils. Open rhinoplasty is when the cosmetic surgeon creates an incision at the bottom of the columella (in between the nostrils) and performs the rhinoplasty by opening up that area. An experienced facial plastic surgeon should assess each patient’s needs individually and recommend the best approach to achieve the desired results.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 170 reviews

An open rhinoplasty allows the surgeon to see more of the tip

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An open rhinoplasty is where the cut also goes across the columella (the bridge of skin that separates the nostrils). The scar is placed in a way that means it is virtually invisible other than when someone is looking very closely at you. Try drawing a line across this part of your nose (with washable ink!) and look in the mirror. It is surprising how dificult this is to see. In addition to this cut, there will still be cuts inside the nose, running parallel to the borders of the nostrils. 

A closed rhinoplasty is where only the cuts inside the nose are made. This was originally developed to be used to fix broken noses, where more refined work on the tip is not usually carried out.

If you think your tip is absolutely fine, the closed approach might be right for you. If you think you need your tip working on, then the open technique is best (in my opinion).

I prefer the open rhinoplasty technique whenever I am operating on the tip. In my opinion this allow much better visualisation of the skeleton of the nose, in particular, the tip of the nose. The tip is a very complex structure and requires sub-millimetre precision. My feeling is that this can only be achieved when the surgeon is able to get a proper look at the tip cartilages. 

The open approach also allows more precise placement of stitches and grafts to reshape the tip.  

Occasionally (although, this is very rare in my practice) I find myself not operating on the tip. In such cases a closed approach can be suitable. However, I almost always find myself thinking that an open approach is best, just in case anything unexpected is found (such as previous trauma to the tip).

These days, most surgeons perform open rhinoplasties. The number of surgeons performing closed surgery has been steadily reducing. However, there are some excellent senior surgeons who argue very convincingly that the closed approach is also very good for the tip.

Thanks for the question, I hope you find this answer helpful.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.