Limitations of Closed Rhinoplasty?

Question

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

John Diaz, MD · Answer

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.

Otto Joseph Placik, MD · Answer

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.

Toby Mayer, MD · Answer

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.

Michael A. Persky, MD · Answer

Hi Ricardo,
Open and closed are approaches to performing the rhinoplasty operation.  I agree with both Dr. Waldman and Dr. Pearlman that excellent results can be achieved with both approaches.  Dr. Rollin Daniel, a very well respected Newport Beach rhinoplasty specialist takes it one step further and performs a "closed to open" rhinoplasty.
Personally I find it easier to secure cartilage grafts with the open approach.
Choose your rhinoplasty surgeon based on results, skill, experience, and the noses of the office staff (if they have been operated on by the surgeon).
Good day.
Dr. P

Jeffrey E. Schreiber, MD, FACS · Answer

Limited tip work and slight reduction in the "dorsal hump" region of the nose can be done via a closed approach. More extensive tip work and significant reduction in the height of the nose usually requires the open approach. Both can be done as an outpatient and are pretty well tolerated. Good luck!

Amir M. Karam, MD · Answer

For some surgeons, this topic is like religion. I do about 60% open and 40% closed. Some have strong views that one approach is superior compared to the other. Some surgeons get excellent results using the open (external) and others get equally excellent results using a closed (endonasal approach. 
So as a patient, the most important thing is to assess your surgeons credentials, experience, and the before and afters. If you like the "look," they achieve on a consistent basis, then that is all that counts. The approach that is taken to get it is less important.

Tanveer Janjua, MD · Answer

The nasal tip can be modified, shaped and contoured very well with closed rhinoplasty.
In fact it has an advantage over the open rhinoplasty because the tip swelling after surgery is less with the closed rhinoplasty.
The only time an open rhinoplasty is preferred is in revision rhinoplasty where the scarring might be extensive.
Ask your surgeon what she or he is comfortable with instead of focusing on what approach to use i.e., closed vs open
Regards

Steven J. Pearlman, MD, FACS · Answer

Surgeons experienced with closed, or endonasal rhinoplasty, can get equal if not superior results to open rhinoplasty for most primary conditions. There is less de-construction of the nasal elements. Also, results can be checked during the procedure. I perform endonasal rhinoplasty for approximately 90% of my primary rhinoplasties and feel that my results are comparable to any open approach.
It is more important to go to a surgeon who is a rhinoplasty expert and understands the nuances of this operation than to pick one small incision difference. To read more about my thoughts on incisions, you can visit my blog at: http://mdface.wordpress.com/2009/02/10/open-rhinoplasty-vs-closed-endonasal-rhinoplasty/

Ryan Greene, MD, PhD · Answer

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.

William Portuese, MD · Answer

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.

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