Closed verses Open Rhinoplasty
Thank you for your question. As a member of The Rhinoplasty society the majority of us can perform both open or closed rhinoplasty. I perform both open and closed rhinoplasty. In reviewing your photographs, in my opinion you are a candidate for an open rhinoplasty. It is important to remember the comfort level of your surgeon and the approach he recommends. Best wishes in your upcoming surgery! Sincerely,James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society,
AAFPRS, OTO/HNS, ASLMS
Performing rhinoplasty without external incisions
The debate between open or closed may never end. As other rhinoplasty surgeons have stated, either approach can be appropriate. The method (ie. open or closed) the surgeon accesses the nasal cartilage or bone may not be as important as to what is done to the nasal cartilage and bone. I perform primarily closed rhinoplasty, even in revision rhinoplasty. However, every physician will vary, and trusting your surgeon is important.
Open or closed is not important
what is important is what is done during the surgery. Open versus closed doesn't determine that. If your surgeon prefers closed, then go with that. It's all the other manipulations during surgery that matter (sutures, grafts, cartilage excision, skin thinning) the most. I do mostly closed but I do all the same things that most surgeons do open. It's preference more than anything else. Technique determines results.
Open or Closed Rhinoplasty
Nasal surgery may be performed using an open or closed technique. With an open rhinoplasty the tissue is manipulated through a small incision made on the tissue separating the nostrils, known as the columella. This technique allows the surgeon greater access to the structure of the nose to better add support and treat issues. This small incision made at the base of the nose is very small and heals into a fine line that is difficult to see. A closed rhinoplasty does not require an external incision, but it may only be used in certain cases as there are limitations. Incisions will be made entirely within the nose. It is up to the Surgeon and his expertise when deciding what type of Rhinoplasty he would like to perform.
Closed versus open rhinoplasty
Closed versus open rhinoplasty is only about the approach, not what is accomplished on the inside of the nose. Closed rhinoplasty involves placement of all of the incisions on the inside of the nose, while open rhinoplasty involves the very same incisions on the inside of the nose with an additional incision across the columella. More important than the approach, is the results of your surgeon has demonstrated in their before and after photo gallery on noses that are similar to your own. For more information and many examples of close rhinoplasty, please see the link and the video below
Rhinoplasty Open Vs Closed
The procedure that works best is the one that your surgeon get the best results from. Open rhinoplasty allows the surgeon to see the underlying structures without pulling upon them. This allows the cartilage and bone to be sculpted without any distortion producing a natural and refined nose.
Open or closed is surgeon dependent. I prefer to perform the majority open because I feel in most cases you have better visibility of the underlying structures. Best of luck.
You can get a nice result with either technique. You would benefit from tip refinement, tip upward rotation, slight dorsal reduction with bridge narrowing and slight alar base narrowing. All these steps can be done with either technique and different surgeon have their own preferred technique. The better exposure provided by the open technique is the reason it is preferred by a majority of surgeons these days. Best wishes, Dr. T
Open or closed rhinoplasty
There is no one "right way". If your surgeon feels confident that he can get you the result you desire with a closed approach then you should be ok with that. See photos of other patients he has done and be sure you like his results. It's a mistake to try to fit yourself into any named technique, but rather have your surgeon use whatever techniques he/she is comfortable with to get you your desired result.
Open or close rhinoplasty?
Without hesitation I recommended open rhinoplasty for you. In my experience, closed rhinoplasty limits what you can do. Open rhinoplasty allows to the visibility to perform for size maneuvers and shaping that otherwise is not possible.