Would you use closed or open rhinoplasty in my case? Hard or easy nose to fix? (Photos)

Hello doctors! I'm planning on getting rhinoplasty this winter and have some issues. I have a hump on the bridge, a hanging columella and a litte bit of an alar retraction. Apparently, according to the doctors I've seen so far, my skin is thin/normal. What do you think in my case? Would you rather use closed or open rhinoplasty? What are my chances of getting a pretty nose? Do I need a chin augmentation in order to get a good result? Thank you!

Doctor Answers 25

Rhinoplasty and chin implant candidate

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From the limited photographs presented, it appears that there is a recessive chin profile along with an overly projecting nose and a dorsal hump.  A closed rhinoplasty approach can accomplish decreasing the overall projection of the nose, shaving down the dorsal hump, and reducing the hanging columella  with all of the incisions placed on the inside of the nose.  No external incision is needed..  The alar retraction may be able to be addressed with just a reduction of the hanging columella alone.  Thin versus thick skin can only be made  upon an in-person examination of the nose.  Consider a chin implant to bring the chin forward to help with facial balance and proportions, especially with respect to the projection of the nose from the side profile.  Chin implants are manufactured out of Silastic,  and are manufactured in the large variety of sizes and shapes.   They can be inserted as a stand-alone procedure under local anesthesia, or in combination with a rhinoplasty procedure simultaneously under general anesthesia. For more information and many examples of  chin implants and closed rhinoplasty, please see the link and the video below


Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Open Rhinoplasty Offers More Precision

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Your tip needs only modest changes, and that sagging columella and nasal dorsum could be addressed with a closed or an open rhinoplasty. Although I used exclusively closed rhinoplasty early in my career, the advantages of an open approach now allow much more flexibility and precision in making small changes, and I find the scar to virtually never be an issue. With precise dissection, the healing time is not increased. Many of the revisional surgeries that I do are on patients who have previously had a closed rhinoplasty elsewhere, and subtle asymmetries were either not recognized or not successfully created. I liken the analogy of asking a car mechanic to fix an engine while strictly working from underneath: Although it can be done, it is more difficult to be precise. 

You do have a recessive chin, and facial proportions would be optimized with a chin implant as well, but you could get a nice result without one.  Many of my patients decide to forgo a chin implant with a recessive chin, and they still wind up being very happy with the outcome.

Would you use closed or open rhinoplasty in my case? Hard or easy nose to fix?

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There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

In the operation that needs the bone and cartilage tissues to be involved; open approach is used. In the procedures with open approach, the size, shape and functionality of the nose can be improved. The big nasal bumps can be removed and septal deviations can be corrected providing a better nasal airway.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.8 out of 5 stars 102 reviews

Rhinoplasty

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From the limited photos here, it appears that you have skin that is on the thinner side.  If you are looking to address your nasal hump, hanging columella, and alar retraction, that can usually be done using a closed (no external incisions) approach.  To determine if you need a chin augmentation, I'd need  a proper in-office evaluation.  Please consult with a board certified specialist who can help you achieve the results you seek.  3-dimensional computer imaging can also help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Closed or open rhinoplasty

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Dear nicolenisrin, The question of whether a closed or open rhinoplasty best suits you has more to do with the surgeon's comfort. Either technique can be employed with your case and it is best to discuss with your surgeon which they suggest as the best approach for you. The incision for an open approach heals nicely and should be barely visible. Initially there is more swelling, but that resolves quickly. You would benefit from a hump reduction and to address your collumelar show, you may need rim grafts and a tongue in groove technique. Based on your profile view, a small to medium chin implant may improve your profile as well. Best of luck to you. 

Eric J. Yavrouian, MD
Glendale Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Rhinoplasty

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Great question!  I think your issues are reasonable and you could get a nice result.  The issue of open vs closed is more about comfort of the surgeon.  I personally perform almost all of my noses closed as I have found this decreases the swelling, creates a more stable construct, and the scars are hidden.  Especially with thin/normal skin you will be able to see the changes and refinements very well.  The bump on the nose would be addressed by trimming the the excess bone or excess cartilage in that area; the hanging columella could be fixed my removing the excess cartilage, and the alar retraction could be improved by placing cartilage grafts in that area.  However, the best recommendation can be provided with an in person consultation so that a proper physical examination can be performed.  

Best of luck and hope this information helps!

- Dr. Roger Tsai

Roger Tsai, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 17 reviews

Would you use closed or open rhinoplasty in my case?

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From your photos you appear to be an excellent candidate for a very good improvement. I perform almost exclusively closed rhinoplasty. My reasons are that I don't have to peel the skin off the nose to know what the anatomy is, tip swelling resolved quicker in closed procedures and simply put there is no scar like no scar.

Curtis Perry, MD
Downey Facial Plastic Surgeon
4.8 out of 5 stars 19 reviews

Rhinoplasty

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Hello and thank you for your question.  Your case can be performed either open or closed for a nice result.   Based on your photograph, you may benefit from fixing your hanging columella, alar batten grafts to address your alar retraction, and a conservative dorsal hump reduction.  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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Open or closed

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Your nose can be done closed.

You need a graft to raise the low radix, the bridge needs to be straight instead of convex and the columella needs to be brought to proper position.

A chin augmentation would put the icing on the cake. Go for it.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Rhinoplasty

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Thank you for your question and photos. The choice of open vs closed approach to the rhinoplasty depends on surgeon preference, not so much on the nose. Your nose does not have major deformity so it should be reasonable to expect good results. Your chin is slightly small so you may consider a chin implant but this can be determined at your consultation. Good luck

Jeffrey Jumaily, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

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.