Closed or Open Rhinoplasty - What Do I Need Done? (photo)

I have a lump on my nose that i would like removed. I do not want to change my nose drastically (only my profile really bothers me). However do i need narrowing of nose and projection of nasal tip, as some doctors have said? I am tempted to consult the doctor who suggested closed approach with rasping of bridge and nothing else, but worried about width of my nose mainly. What are your thoughts based on photos.

Doctor Answers 14

Closed or open rhinoplasty

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A closed rhinoplasty technique is usually all that is required for a primary rhinoplasty.  Once the hump is removed osteotomies will be performed to straighten and slightly narrow the nasal pyramid.  If not, a flat-topped or square-topped nose will result, which will be aesthetically unpleasing.  A simple hump removal and osteotomies is all that is required and will not drastically change this type of nose.  No added projection to the tip is needed.

Rhinoplasty To Address A Nasal Bump

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Dear Smitzkoff,


Based on the photos you have attached, the technique of how to remove your nasal bump will be determined after physical examination as it will not dictate the nature of your end results; the skillfulness and experience of your surgeon should be the main element for a winning equation. Nonetheless, it seems that you may need osteotomies after rasping the hump.

Your nasal dorsum is wide and making a narrower nose would enhance your facial beauty greatly. I believe that you would benefit from a consultation with a board certified surgeon of extensive experience who can guide you to make a well informed decision after examination.

Thank you for your inquiry.

The best of wishes to you.

Dr. Sajjadian


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It is not a matter of need it is a matter of want and addressing what you do not like. The hump on the bridge could be addressed open or closed but it is sufficiently large that I suspect you will need an infracture to close the open roof after its removal. I do not think rasping the bridge alone will give you an optimal result. That will change your profile dramatically whether or not you do anything to the tip.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Closed vs Open Rhinoplasty

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I have done both open and closed rhiinoplasty for over 35 years. In fact my partner and I were two of the first four surgeons to do open rhinoplasty in the United States, but your nose could be done either way. As I have said many times, pick the experienced surgeon with results you like, not the technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Deciding on What Should Be Done in a Rhinoplasty

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The conversation so far has been insightful.

1. The approach (open vs. closed) is not the most important factor (both will work well).

2. If you have the dorsum rasped you will need to in-fracture the nasal bones in order to avoid an open roof deformity.

There are 2 other things to keep in mind. First, changing one part of the nose often changes the overall appearance of the rest of the nose. Second, since the nose balances the rest of the features on the face, changing the nose will also change the overall appearance of the rest of your face. Both of these factors often change your appearance in ways that you may not anticipate. Computer imaging in your case may be very helpful by showing you what each incremental change would do to your overall appearance. Commonly people come in to see me thinking they want a very small change done (like rasping the dorsum), but when they see the imaged picture of this small change, do not like the way it makes the rest of their nose look. Imaging may be a good place for you to start in order to be sure that you will ultimately get the result that you desire. Good Luck.


Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 27 reviews

Closed or Open Rhinoplasty - What Do I Need Done?

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Thanks for the posted photos. Either option can work , BUT you need lateral osteotomies (fractures!) to close the open roof from just rasping. Seek in person additional opinions. 


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If you are only concerned about the profile view of the nasal hump and nothing else, you could probably undergo a closed rhinoplasty approach.  However, rasping the hump will likely be insufficient (depending on how big the hump is) and you will likely need osteotomies to close an open roof defect from just rasping it down.  Please consult with a board certified specialist who can best assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Closed or Open Rhinoplasty - What Do I Need Done?

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For what you are seeking, a Closed Rhinoplasty would be the best option IMHO.  It would allow reduction of the dorsal hump with little change elsewhere on the nose.  Hope this helps.

Open vs closed rhinoplasty

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The surgical approach is the last variable in rhinoplasty. There are excellent surgeons who only do noses open and others like myself that do most closed and the results are really not superior for either. However when large nasal humps are removed it is always necessary to do osteotomies to close what is called an open roof. Rasping alone will leave a flat-top


Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 134 reviews

Closed or open rhinoplasty?

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There is no one right way to do a rhinoplasty. The desired result is what counts. I perform both and decide which based on what I think will give me the best chance to achieve what the patient is looking for. That's what you need to keep in mind when picking a surgeon. Not the tool he recommends but how comfortable you feel that he/she understands your goals and you have seen examples of his/her work that verify it. Good luck!

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

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.