Is It Possible to Narrow the Nose Tip, with Closed Rhinoplasty?

Closed or open rhinoplasty are both in essence the same procedures, the only difference is the exposure that is provided with the open approach.  In my hands, for the past 20 years, I have preferred the open approach for what I feel are its superior advantages.

Closed Rhinoplasty, also known as "endonasal rhinoplasty" can narrow the tip of the tip of the nose.  The exposure of the  cartilages in closed rhinoplasty is sufficient to identify and modify the tip cartilages to an orientation and configuration such that the tip is narrowed. 

Rhinoplasty: cam be  opened, or closed,

the boxy tip can be fixed alone with a tip rhinoplasty

The round, bifid or separated tip can be best improved by:
Open method
Tip sutures in the dome
Narrowing
Cartilage removal
 

As a surgeon who has performed closed, or endonasal rhinoplasty for over 23 years, most modifications on the tip or any part of the nose can be done through a closed approach. I find results are equally as good for an experienced rhinoplasty surgeon.

My indications (reasons) for doing an open rhinoplasty a very crooked nose, need to add many grafts to the nose and in complex revision Rhinoplasty. That means, in my book, i perform over 90% of primary rhinoplasties using the closed or endonasal approach.

Yes. Almost anything that is done in an open rhinoplasty can be done in a closed technique provided the surgeon is very experienced. I perform open rhinoplasty most of the time because I think it gives me the best opportunity to give predictable excellent results. I used the closed technique when the nose is not very complicated and most things are in the right place. The most important thing is the final result. The columellar scar heals very well and should not really be an issue.

You may be able to do something surgically i.e. it is in the realm of possibility but that does not mean you should do it. If you narrow the tip by only removing some tip cartilage that can be done reliably well open or closed. If you also need sutures placed to align and reposition the tip cartilages there is a chance that that cannot be done reliably in a closed approach. It depends on what exactly needs to be done and your surgeon's skill, experience and comfort level. The trade offs of a small scar on the columella and a longer period of swelling after surgery certainly outweigh the risks of revision surgery in specific cases.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

The closed rhinoplasty is an approach to the procedure, not the technique itself.  Tip plasty can be performed through either closed or open approaches.  The important part of the procedure is what is done with the actual cartilages such as suturing, tip cartilage grafting techniques, and removal of thick wide excess cartilage is what will effect the change.  In closed rhinoplasty all incisions are made inside the nose, while open rhinoplasty makes the incision across the columella in addition to the internal incisions.  The open rhinoplasty takes longer to heal.

Absolutely. All rhinoplasty was dine closed up until about 25 years ago when dr goodman popularize the open techniue. Most of todau's young surgeons are not trauned in the closed procedure

Many cosmetic surgeons prefer to perform a closed rhinoplasty. Those who perform the surgery often through the closed technique are comfortable modifying the tip that way. The more modifications that are made the more difficult it can be to perform the surgery through a closed technique. Most surgeons get comfortable with a certain technique. Once they get good at it, they stick with it. Good luck.

As 95% of themrhinoplastys I do are closed, yes a tip can usually be narrowed using the closed technique.