Thank you for your question. You are asking the wrong question. You should be more concerned about finding the right surgeon for you. Someone who you can be confident with will do the best job to give you the results you desire. It's up to your surgeon to use the approach he or she feels will work best for you.
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
The open versus closed rhinoplasty debate is only about the actual incision across the columella. That is the only difference. All of the maneuvers that are performed on the inside of the nose to make the required changes can be performed with either open or closed approach. Look for a surgeon who has dedicated a significant component of their practice to the discipline of rhinoplasty and performs them often on a weekly basis for a very long period of time. For many before and after results of closed rhinoplasty, please see the link and the video below
Greeting Thank you for your question. 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.
Becky, great question. Not only that, but one that is exceedingly common amongst patients. I agree with the sentiments that have been expressed previously to be honest. At the end of the day, it really all depends on the comfort level of the surgeon. I, for example, will do 80-90% closed rhinoplasty unless its a revision that needs a lot of tip work, I physically cannot work through the nostrils due to size, or I am not getting the results I want at the end and just want to polish things with a little more direct vision. Obviously these aren't hard and fast rules for me, but the way I usually approach things. That being said, this is what I do myself. Other surgeons do it open, and have always done it open, and do a great job at it. There are pros and cons to each technique, and your surgeon should be able to give you an insight into why he likes to do it one way over the other (that discussion is too long for this particular forum). Either way, the more important thing is that you feel comfortable with your surgeon and the surgical plan. Best of luck on your surgery. I hope some of this helps.
Not only with the open you not only have a visible columella scar- you will also experience a much longer period of swelling of the entire nose due to the extensive and in my opinion- unnecessary exposure of the nasal anatomy. The open technique dissects and reflects up and off the nose in order to achieve the visible exposure to the anatomy. In y opinion- in the experienced hands- this is unnecessary. In a primary Rhinoplasty the internal technique has the best opportunity to achieve the best nose with minimal post-op swelling.
Many would argue that there is more control with the open approach, especially with more complex tip problems. The reality is that it depends more on the surgeon than the approach. IF....the surgeon can do the result best or equally well closed, then that is preferred. If the surgeon feels she/he has better predictability and control open then that is preferred. See before and afters and have a frank discussion during your consults about WHY that particular surgeon feels their recommended approach is best for your case.