What's a better method for a very long, hooked, bulbous, Italian nose; closed or open Rhinoplasty?

I usually perform the closed rhinoplasty approach so that there is not a visible scar.  Either approach can be used.Find a board certified plastic surgeon who performs hundreds
of rhinoplasties and rhinoplasty revisions each year. Then look at the
plastic surgeon's website before and after photo galleries to get a
sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

This absolutely depends on your chosen surgeon as opposed to your nose. If you seek a handful of consultation you will likely receive differing advice about the approach from different surgeons. The bottom line is that different rhinoplasty surgeons will use different approaches for the same nose and that is OK. If you trust your chosen surgeon and like their before and afters for noses similar to yours the approach that they use should be less important than their skill, experience and results. I hope this information is helpful.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

First and most important is what needs to be done to make your nose more balanced and more to your liking.  At a consultation you can discuss what the problems are and listen to options or recommendations for improvement.  Part of the discussion will be open or closed.  The key is to get a consultation with an experienced board certified plastic surgeon who has an expertise in noses.

 The debate about open rhinoplasty versus closed rhinoplasty is only  about the approach to the surgery, not the surgery itself.  With closed rhinoplasty, all the incisions are completely located on the inside of the nose.  No external incisions are required. Addressing the bulbous tip, large hump, hooked and long nose can all be addressed through either closed or open rhinoplasty. We perform closed rhinoplasty. For many examples, please see our closed rhinoplasty photo gallery.

Excellent cosmetic results can be achieved
with both techniques. There is not a best way to perform the procedure.
Individual surgeons have their own preferences of how to produce the best
results in their hands. What is more important than whether a closed or open
approach is utilized is the experience and artistry of the plastic surgeon and
your comfort level and confidence in that individual.

Following the advice from a surgeon on
this or any other website who proposes to tell you exactly what to do  without examining you, physically feeling the
tissue, assessing your desired outcome, taking a full medical history, and
discussing the pros and cons of the operative procedure would not be in your
best interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) or a facial plastic surgeon (ENT)  that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California