Closed or Open Rhinoplasty? Price? Can I achieve this nose? (Photos)

Question

Hello! After participating in sports all my life and then joining the military, my nose is no stranger to some sort of impact. I've never broken it though. Would I be able to achieve a nose like how I've edited it to look (I only decreased the hump, shortened the nostrils, and upturned the tip) with a closed surgery, or is open the only way? I also think I'd need to fix my deviated septum so that I can breathe better! Factoring all of that in, how much do you think it'd cost in New York?

Rian A. Maercks, MD · Answer

The rhinoplasty you desire should be performed in an open manner.  I personally have no opened a  nose in seven years outside of cleft lip/nose correction.  For aesthetic rhinoplasty, my strong preference is to leave the columella attached(the difference between open and closed).  This averts the columellar scar, preserves attitional vascularity and speeds the recovery and resolution of swelling.  The most iportant reason, however, is preserving the ability to judge the lipnose/tip relationship which is crucial in a rhinoplasty like yours.  After training with the leaders in craniofacial and plastic surgery almost a decade ago this has been the prinicple for my maintanance of closed technique.  I my opinion there is rarely an indication to open the nose.  I hope this helps!All the best,Rian A. Maercks M.D.

Tanveer Janjua, MD · Answer

The primary issue is the hump. It can be reduced with closed approach easily. It can be done at the same time as septoplasty to help you breathe better. The cost is high in New York between $10,000 to $20,000.In New Jersey you can get it between $3500 to $7500RegardsDr. Janjua

Farhad Rafizadeh, MD · Answer

The morphing that you have done is definitely feasible through a closed rhinoplasty. I use the open thechnique when significant tip work is required, for example if the tip is asymmetric, boxy or bulbous. It is hard to assess your nasal tip on the photographs and give you a definitive answer. The fees for the procedure varies and can be between 8 to 10k. The sepltoplasty can be done through the closed apprauch as well. I like the open rhinoplasty which is extremely useful, but it is not necessary when the tip shape is adequate. Even though the columella scar is alway acceptable, in very few patients it could be visible on close inspection. Therefore when it is not necessary to open the nose, I prefer the closed technique.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. You may also benefit from a cephalic rotation of your tip to turn
up your tip slightly and a conservative dorsal hump reduction.  The deviated septum could be fixed at the same time.  This could be done with either a closed or open approach.  Cost varies based on geographic region and surgeon expertise.   Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Eric M. Joseph, MD · Answer

Your morphed facial profile with nasal hump removal and tip rotation appears to be a reasonable expectation. If you have significant dissatisfaction with your nasal appearance, consider consulting with several rhinoplasty specialists so you could see what to expect after surgery. In our practice, we nearly exclusively use an open approach for achieving a desired and natural-looking nasal appearance. Hope this helps! Dr Joseph

Jeffrey S. Rosenthal, MD · Answer

A rhinoplasty is in intricate procedure that requires balancing the entire nose, not just a segment.  An open approach allows the plastic surgeon to view the underlying structures without pulling upon or distorting them.  Tiny segments of the underlying nose are trimmed and brought together to enhance your appearance.  The final result is a nose that looks natural and still maintains your personal identity. Computer representations do not take into consideration the various underlying structures that must be addressed, if the nose is to look natural and blend with your facial features.  A consultation to address your concerns and find out what can be accomplished is the first step.  View before and after photos of the surgeon's rhinoplasty patients to establish an idea of what is reasonable and possible.  A rhinoplasty is truly an artistic endeavor, which requires experience and creativity by your surgeon.

Matthew Bridges, MD, FACS · Answer

i think your morphed image is probably a realistic expectation.   Concerning open vs closed rhinoplasty, anything that can be done open can be done closed. It's totally surgeon preference.   In my practice, I would probably perform the closed approach.  My website has examples of both.  Good luck!Here's some specific advice, too. If you see a surgeon who does not discuss a radix graft, he/she is not the right surgeon.

Reza Momeni, MD, FACS · Answer

The results you desire can be achieve with both open and closed techniques in good hands.  Costs of plastic surgery depend on the location, how expensive your area is in general, and also the reputation and experience of your plastic surgeon.  You can call a few surgeon offices in the area, and most should be able to give you a cost estimate (or a reasonable range) for what you're looking for.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Jeffrey Watson, MD · Answer

Great questions - and yes - that profile is achievable with your nose if you go to a dedicated rhinoplasty physician. 2 things: 1) there is a lot of cosmetic rhinoplasty being done and the inside of the nose not attended to. So, be sure your physician is a facial plastic surgeon (that means he did 5 or more years of ENT (aka nose and breathing surgery) in addition to the plastic surgery part. You want to have this done during the same surgery. Next, for the changes you are proposing I strongly suggest you have an open rhinoplasty. The ability to achieve symmetry, place grafts, and visualize the anatomy to get it just right is far superb compared to closed. Many surgeons will agree that their open rhinoplasty results are better than their closed results, if they really look. The incision is low, in the shadow under your nose. When closed meticulously, you'll hardly know it's ever there. I wouldn't sweat that part :)
I hope that helps!
Jeffrey Watson, M.D.
Fellowship Trained Rhinoplasty
Specialist
Graduate, Harvard Medical
School

Harry V. Wright, MD · Answer

The difference between an open and a closed rhinoplasty is the approach. Most facial plastic and general plastic surgeons can perform either approach, and the decision is informed by what type of reshaping maneuvers we're trying to accomplish. Additionally, the open approach is preferred in patients who have had nasal trauma or prior nasal surgery (where we anticipate an increase in the technical difficulty of the procedure). 
 
 In a closed rhinoplasty the incisions are hidden inside the nostrils and all of the work is performed through those incisions. There is no external (skin) incision, so closed rhinoplasty carries the least risk for visible scarring. Small to medium-sized hump reduction and many other rhinoplasty techniques may be performed via a closed approach. 
 
 For me, to obtain the most control over the nasal tip for projection, definition and symmetry, the open approach is the way to go. Think of it like this: if you want to do technically precise work on the engine of a car, you'll want to raise the hood (open rhinoplasty). The skin incision almost invariably heals well, and for tip reshaping the control that you gain with the open approach outweighs the risk of the skin incision. 
 
 Even more important than the type of procedure is finding a Board-certified Facial Plastic Surgeon who you are comfortable with, who you trust, and go with their fully-informed recommendation.Best wishes!  Harry V. Wright MD, Sarasota, Florida

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