Limitations of Closed Rhinoplasty?

What are the main limitations of closed rhinoplasty? And how much work can be done on the tip in closed rhinoplasty, if any?

Doctor Answers 17

No limitations with closed rhinoplasty

There are no limitations with a closed rhinoplasty. All of the surgical techniques that are performed through an open rhinoplasty can be performed through a closed rhinoplasty. The only difference is not having to make the incision across the columella.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

No limitations with endonasal rhinoplasty

While to many surgeons this is still a hot debate, in my opinion, this is an old, boring topic. The majority of experienced rhinoplasty surgeons understand that there are merits to both the external and endonasal approaches. There are really no limitations with either approach; rather, surgeons just happen to be comfortable with one approach over the other. While I personally prefer the external approach, I appreciate the face that endonasal (sometimes called closed) approach is an elegant approach that has many advantages. I personally do not think that a patient should choose a surgeon based on the approach that the surgeon utilizes; great results can be achieved with either approach.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
4.9 out of 5 stars 82 reviews

Closed vs Open Rhinoplasty

My preferred approach is a closed rhinoplasty.

Critics of this approach say that it is more difficult to perform complex maneuvers of the tip of the nose. They also feel that it is more difficult to work on the septum using this approach.

I have a lot of experience using the closed approach for complex tip and septum work. I personally feel that there is nothing that can't be done using a closed approach.

However, I recognize that some surgeons feel that the open approach is better.

I think that it all depends on the surgeon and how comfortable you feel with the surgeon's ability. If they show you great results that are consistent with what you want, then it really doesn't matter which approach is used.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Open vs Closed Rhinoplasty

The limitation of closed rhinoplasty really depends on the surgeon doing the procedure. I have been a strong advocate of the open approach for many nasal problems for many years. However, I still use both techniques. Many respected surgeons never do an open rhinoplasty . Choosing a surgeon is much more important than choosing a technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Most people only need closed rhinoplasty.


I think it's all about the experience of the surgeon.  Open rhinoplasty is easier because you can see the cartilages.  But it is really more surgery than most people need. 

I do closed rhinoplasty (including refining the tip) on most patients.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Depends on the surgeon's skill and judgement

the debate over which approach is best rages on, but in the end it depends on the skill and judgement of the surgeon, his experience, and proper assessment of the patient's deformities, strength of cartilages, skin thickness, and other factors. The external or open approach is often better for revision cases, complex tip deformities, cleft rhinoplasty, and for saddle nose deformities, as well as cases requiring precise cartilage grafts, in my experience of over 29 years of practice.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Open vs. Closed Rhinoplasty

The surgical approach for any rhinoplasty is individualized. A closed rhinoplasty is usually a reduction rhinoplasty, meaning that portions of cartilage and bone are usually removed. This can be a very acceptable approach for many tip problems. However if extensive suturing of the cartilage is needed then an open approach may be beneficial.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Closed rhinoplasty limitations

The limitations of closed rhinoplasty are the lack of the extensive exposure that you have when performing an open rhinoplasty. When a rhinoplasty is particularly complex or requires many grafts, it may be more difficult to achieve with a small incision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

It depends on the surgeon and the extent of the surgery.

We have been doing open rhinoplasty for more than 30 years. In those days we were called heretics! Today, almost all rhinoplasty surgeons do open rhinoplasty on many of their patients. But there are some noses I still do closed. It depends on many factors.

You should choose an experienced rhinoplasty surgeon who does natural looking noses that you like. Then let him guide you as to which is for you.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Closed versus open rhinoplasty

A closed rhinoplasty has been a long standing approach to nasal surgery.  I personally find open rhinoplasty a bit more precise in treating complex septal deviations, and tip problems.  A straightforward dorsal hump reduction with limited tip work can be done closed. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.