What Hurts Less - Open Rhinoplasty or Closed Rhinoplasty?

Hi Em,

With anesthesia, neither hurt during the procedure.  There is surprisingly very little pain associated with either open or closed approach rhinoplasty.  With both, you should only feel a slight bit of nasal congestion, and at worst a sinus type pressure headache.  Most patients get by on just plain Tylenol though they are given Vicodin just in case and for at bedtime.  The most uncomfortable aspect of Rhinoplasty is if your surgeon uses intra-nasal packing after the surgery.  I and many other rhinoplasty surgeons no longer use nasal packing so that our patients can experience a more comfortable recovery.  Choose your rhinoplasty surgeon most carefully.

Dr. P 

Since pain is experienced completely
subjectively, the level of pain you will experience during your rhinoplasty is
entirely relative. Either way, you will be administered local or general
anesthesia, and should thus be numb to any pain during your surgery. The
decision to perform an open or closed rhinoplasty should thus involve the
structure of your nose and the goals that you and your doctor have agreed upon.
If you are worried about the level of discomfort involved with your nose job,
talk to your doctor about post-op care and medications that can be prescribed
to reduce pain. 

There really should be no difference in the pain level after either an open or a closed rhinoplasty. Either procedure is not particularly painful. Patients usually note a level 1-2 of pain on a scale of 10. The only difference may be in swelling in in the postoperative period.  Every patient has different threshold of pain, so it is difficult to predict. Most of our patients do not take medications other than Tylenol in the immediate postoperative period, however there are those whose medication needs are higher.

I am not sure if this has ever been definitively answered. It is my impression that the open may involve silghtly more swelling and therefore more inflammation and pain but this is only an educated guess. In my opinion there are not significant differences in the pain levels.

There are no studies that I am aware of  to say one way or another. Pain is a very individual thing.   The pain from rhinoplasty is usually well tolerated.  Ice, elevation, and modern pain medicine all help to make this a very tolerable experience. 

I couldn't find a single published study comparing pain between the two nor have I ever seen a measurable or consistent difference in pain between open rhinoplasty and closed rhinoplasty. I suspect that--patient factors aside--the gentler surgeon probably produces less trauma and thus less pain regardless of approach. Find a surgeon who's gentle when examining your nose in the office and who doesn't take a hurried approach. 

All the best,

--DCP

Hi emilyyeasbel in passaic new jersey,

Pain is somewhat unpredictable, as each person is unique. However, both approaches have similar postoperative discomfort level. Facial or sinus pressure after rhinoplasty are more common complaints rather than severe pain. More important than the approach to rhinoplasty, is the level of complexity of rhinoplasty. The more surgery that is performed, then the more discomfort one may experience. Minor procedures have minimal, if any, discomfort. Speak with your rhinoplasty surgeon to help determine appropriate guidance for you. Best of luck.

Dr. Chaboki

I don't think one approach causes more pain than the other, but I think that in general the swelling after an open rhinoplasty, particularly at the tip, can be a bit more than in a closed rhinoplasty and can take longer to go down-- for some folks this may cause some increased discomfort, but I think this is minimal.  

I would expect the pain to be similar after rhinoplasty - open or closed. Suture removal (unnecessary for closed approach) may be uncomfortable after open rhinoplasty but certainly very tolerable with the help of numbing cream.

At the end, pain levels should not determine the rhinoplasty technique used. Rather, whether the surgeon is able to accomplish everything.

Thanks for the question. I perform both open and closed (endonasal) rhinoplasty and in my experience, patients report that their postoperative pain is mild with either approach. Pain medication is usually needed for only 2-3 days following surgery.

I would leave it up to your surgeon to decide whether an open or closed technique would be more effective for your rhinoplasty. The decision should be made on the basis of which issues in the nose are being addressed as well as the surgeon's training and experience with each approach. I have found that the small incision on the columella in open rhinoplasty heals quite beautifully and the slightly longer healing time is certainly worth it if your surgeon feels that the results will be better (in his/her hands) with the open approach. 

Regards,

Dr. Mehta