Closed Rhinoplasty to deproject/ reduce length of a long ethnic nose? (Photo)

If a particular surgeon has years of experience with closed rhinoplasty and you see photos of his/her work and you are happy with what the results are, then it can be done. Many surgeons that utilize only open techniques will tell you it can't be done closed. Open or closed is not important - the scar heals great. The most important thing is the experience of the surgeon and if the before/after photos are something that you really like.

Hello and thank you for your question and the pictures. You actually have a difficult problem. To properly address your nose and improve your facial balance, you would need an open rhinoplasty with nasal tip deprojection to improve the overall harmony of your different facial features. Only the open approach would allow for all the maneuvers needed during surgery to achieve your goals for your nose.

This truly a surgery of millimeters- and tip deprojection is one of the most technically challenging surgical techniques! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Based on your profile photo, you appear to have relatively thick nasal skin with an overprojected and droopy nasal tip appearance and a profile hump. I think your list of expectations is reasonable. Please consider meeting with several reputable rhinoplasty specialists who offer computer Imaging so you could see what to expect after well executed surgery. Hope this helps! Sincerely, Dr Joseph

Hi from Istanbul! It is entirely feasible to achieve deprojection using a modern closed rhinoplasty approach. Whether through an open or closed rhinoplasty, the necessary adjustments, as you've described, can be effectively accomplished in your case. Therefore, I would advise you to pick the surgeon you feel most comfortable with and leave the surgical planning to them. Best of luck!

I do not recommend the closed approach when there is any significant change in tip position, including shortening, deprojection, and significant changes in rotation. Open rhinoplasty allows for direct visualization, precise changes in tip position and stabilization of the tip in the right place, redraping of the skin and soft tissue to match the new framework created during surgery, and release and restoration of the Pitanguy's ligament which acts as a leash on the tip of the nose and is implicated in supratip deformity after closed rhinoplasty.

I will have to agree with the two younger surgeons. An open rhinoplasty will provide the best control, and the best chance of changing all of the features you would like, having trained in both open and closed rhinoplasties. There is a little benefit to treating your nose with a closed technique.
Jed Horowitz, MD, Newport Beach, California

You are much better off doing an open approach. The surgeon can see better with both eyes to make a better result. You have multiple things going on that requires you to have a more extensive operation. It would take about 2 hours to perform and I recommend an open rhinoplasty.

Best Wishes,

Gary Horndeski, M.D.

Yes this can be done either way. I often do rhinoplasty with a closed approach to deproject and rotate plus work on those other areas. I don't see any reason why this cannot be achieved in a closed fashion.
The surgery would take about one hour.

If your septum is perfectly straight, and the surgeon is facile at both securing a specialized cartilage graft to the septum to hang the tip cartilages on, and performing tip suturing techniques in a closed nose, then a closed rhinoplasty is possible. In general, it is unlikely older surgeons can fulfill those criteria. Open rhinoplasty is the most common way to execute these complex maneuvers and one should not feel that open rhinoplasty is less than closed. The resulting scar is literally imperceptable.

To me, there are advantages and disadvantages to performing a rhinoplasty open. The only disadvantage is the teeny tiny scar that happens across the columella. I've never had a patient complain about the scar, and in many patients we can't even find it later, even knowing it's there. The advantages of the open technique are massive: the ability to diagnose more easily and accurately what is causing the shape that we want to change, knowing better what to do and how much, having more options, seeing the anatomy in its natural position. I personally wouldn't attempt your rhinoplasty closed.
This operation is hard enough, I'd recommend finding a surgeon who can prove he has the skill to accomplish what you want, and then let him use whatever techniques have made him successful so far.

How *much* to elevate the tip, or deproject the nose, or make the other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.