Confused About Which Type of Rhinoplasty

I'm 22 and really considering having a nose job, but a plastic surgeon told me that my tip needed correction and that it would be easier to do an open nose job instead of a close one. I really don't want a scar on my skin, and I just want my bump reduced. What do you think I should do? Do you think I should get some correction on my tip? Thank you very much!

Doctor Answers 15

Choosing Rhinoplasty Type to Reduce Bump on Nose: Open or Closed

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Hi pennybrigitte in Baltimore,

Rhinoplasty is not one operation, but many potential operations. Every patient is unique. Reducing the hump from a nose is the most common request for cosmetic nasal surgery. Humps are usually made up of both cartilage and bone, and come in various sizes and shapes. Reducing small humps is a relatively easier procedure, as compared to more extensive rhinoplasty surgery. Large bumps will require bone reshaping/breaking after the hump is removed.

A goal in nasal surgery is to recreate balance of the nose with the rest of the face. A small hump may be filed or rasped without needing more surgery. A subtle change in the nose may create a profound improvement in facial balance.

Choosing the rhinoplasty type, open or closed (endonasal) is not as important, as compared to the specific goals of the cosmetic surgery. Many plastic surgeons perform both types of procedures. Personally, I perform primarily endonasal or closed rhinoplasty without an external incision. However, I would perform open rhinoplasty for select patients, if required. The columellar incision of open rhinoplasty heals very well & typically barely noticeable once healed.

Only after a comprehensive nasal evaluation can a rhinoplasty surgeon determine the most appropriate option for you. Best of luck.

Open vs. Closed Rhinoplasty

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The technique used for rhinoplasty either open or closed is not as important as the fact that you and your surgeon need to be on the same page regarding the aesthetic goals of the surgery. With an experienced surgeon the open incision on the columella should be undetectable, so this should not be a concern. Digital imaging is an ideal tool to have an idea of the proposed results during the consultative phase. This allows open discussion of your likes and dislikes and helps determine if you and your surgeon are on the same page. Best of luck and I hope this is helpful to you.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 214 reviews

Closed vs open rhinoplasty

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The only difference between closed and open rhinoplasty is the incision itself. All the techniques described for rhinoplasty can be performed either through an open rhinoplasty or through a closed rhinoplasty.
It is a surgeon’s preference as to how they go about getting into the nose to perform the rhinoplasty. The endo-nasal approach or closed approach is done with all the incisions on the inside of the nose and open rhinoplasty is done with the incision across the columella. In experienced rhinoplasty hands you will have excellent results with either technique. We prefer the closed rhinoplasty technique in our practice with a far majority of rhinoplasty patients.

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Types of rhinoplasty

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The take home message when considering the open vs closed rhinoplasty is this:  Surgeons can do either approach badly.  In other words, if the columellar incision is closed poorly, it may leave a scar.  On the other hand, a surgeon not experienced with the closed technique may cause tip deformities, scarring inside the nose, deviation, etc.  External incisions on the nose, closed properly, should be virtually invisible.  Make sure your surgeon shows you before and after photos of results, including the appearance of any external incisions.  Most bad results in rhinoplasty don't happen accidentally.  They are almost always the result of poor technique. 

Closed rhinoplasty with hump reduction and subtle tip rotation

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You are asking many artists how they would achieve their results and you will get many different opinions so I might as well offer my 2 cents worth. The tip of your nose points down slightly and forms slightly less than a right angle with your upper lip. Reducing the bump alone may create the appearance of an overly long nose with a mild "plungling tip" from the frontal view. I would likely advise a subtle rotation  of the tip upwards. This could all be achieved via a closed approach. 

A hump removal doesn't require an open incision

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in my opinion, removing the dorsal hump or narrowing the nose can be done using the open or closed approach. I reserve the open technique for more complicated cases especially if they involve redefining the tip. You might want to get a second or even a third opinion if you don't feel comfortable with the plastic surgeon that your presently seeing

Rhinoplasty Can Be Performed Without External Incsion

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Hi Penny,

It appears that your nose can be operated upon via a closed approach without an external incision.  Consult with a few other rhinoplasty surgeons, but make sure that your choose your rhinoplasty surgeon most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Open or closed rhinoplasty

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Whether to alter the tip or not is solely your decision. If you are happy with your tip then tell the surgeon you don't want to alter your tip. It is certainly very common to reduce the hump without having to open your nose. Find a surgeon who is very comfortable with that approach.  

Norman Ge, MD
Orange County Facial Plastic Surgeon

Type of Rhinoplasty

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Each surgery is individualized, depending on the needs and desires of the patient. Your surgery can be done using the open or closed technique. Pick the surgeon, not the technique. Do not worry about the scar with the open technique - I' ve done a minor revision on two in 35 years. Evaluate your entire nose so you achieve the best possible result.

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

Rhinoplasty options

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My preference in greater than 90% is performing an open rhinoplasty. The small scar under the tip of the nose is barely perceptible even after as little as 6 weeks after surgery,b ut it provideds the best access and visualization to perform accurate surgery.

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.