Is a closed rhinoplasty price different from an open?

Question

I had a rhinoplasty paid £7,000 for what was suppose to be open Rhinoplasty. I've had a trauma to my nose from childhood.I believe it was devaited from then. I have a hard copy from surgeon for open Rhinoplasty. When I get to the surgery, he changed his mind to closed. I wasn't happy with that decision, I needed a surgeon to open up my nose to investigate the extent of the damage of the nasal fracture.I believe I have over paid for a surgery which I didn't have. Got a second opinion, I have been to see a E.N.TMaxFaxsurgeon.He said my nose is still devaited.

Ronald J. Edelson, MD · Answer

Your question is difficult to answer. Good results can be obtained either by open or closed rhinoplasty. The big question in your case is why would a surgeon plan a closed rhinoplasty only to change midstream and perform it open. Whether it was to be performed open or closed should have been determined prior to surgery. Is there a possibility that your surgeon said he would try to do it closed but might have to change to open depending on what was found at the time of surgery?

Munish Shandilya, MS · Answer

Thank you for your question and sharing your reasonable doubts !
Most good Rhinoplasty surgeons nowadays are just that ... good Rhinoplasty surgeons consistently achieving safe predictable  satisfying results. The patients should be informed of the implications of the two techniques and in case of an open approach it would be a good idea to show a range of the columellar scars in your hands. It would also be a good idea to have the flexibility of rarely changing between the two approaches if it is considered to be better for the patient. There is no reason for a cost difference between the two approaches as long as a surgeon achieves. consistently good outcomes through the approach of their choice.
Regarding suboptimal correction ... that may happen through either approach.
I hope that helps.
Best !

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, Thank you for your question. The closed rhinoplasty is an advantage for you, as you don't have a tissue damage. Your deviation may be altered by the Closed and Atraumatic Rhinoplasty which minimizes swellings & edemas, prevents tissue damage and accelerates the healing process. Best Regards

Rian A. Maercks, MD · Answer

Hello, and thank you for your question!
Different surgeons will have different opinions depending on their experience and training.  My opinion is that there is rarely if ever a need to "open" the nose.  A closed approach allows the experienced surgeon complete access to all structures and excellent visualization.  The advantages include a much more vascularized nose ( two big arteries reside in the columella), better tissue envelope to support grafting (which you will need), avoidance of external scarring/notching and very importantly it leaves the lip-columella-tip relationship intact during surgery, allowing the surgeon to more accurately evaluate the aesthetics of the intervention.  It is true that open rhinoplasty is much much easier and requires less technical expertise.  The open approach is much better for training and demonstration purposes.  Personally having trained with world class craniofacial and aesthetic surgeons such as Fernando Ortiz-Monasterio and Molina I adopted their bias that opening the nose is not necessary( outside of reconstructive cleft work etc. ) and is negatively affects healing, graft take and ability to accurately judge the intraoperative result.  Having extensive experience with Mestiso and ethnic rhinoplasty I would suggest you find someone with similar craniofacial and ethnic experience as your rhinoplasty will require advanced grafting technique.
  I hope this helps!
All the best,
Dr. Rian A. Maercks, M.D.

Julian Rowe-Jones, MBBS, FRCS (Eng), FRCS (ORL) · Answer

There is no right or wrong approach for rhinoplasty, there are pros and cons of each.  There are different philosophies about rhinoplasty which tend to be reflected in the different approaches.  The important thing is for you and your surgeon to agree your goals.  There are I am afraid limitations to what can be achieved both open and closed.  I recommend you talk to your surgeon to understand why the approach used was chosen.  This may put your mind at rest.

Michael Elam, MD (retired) · Answer

Each surgery is designed to artistically provide the patient with their desired results. Generally the surgeon will stick to his/her surgical plan however things can change the morning of surgery. When this is the case then a consent should be signed and the patient fully informed of the procedure.  The cost between open and closed rhinoplasty will likely not vary by the surgeon performing the procedure it only varies from surgeon to surgeon as any surgical costs do. I would speak with your surgeon and discuss your concerns.  Best regards, Michael V. Elam, M.D.

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