Closed vs. Open Rhinoplasty?

What is the difference? I've noticed some docs do one and some do the other?

Doctor Answers 14

Closed vs. Open Rhinoplasty?

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Great question.  It's one that's been discussed for years among rhinoplasty surgeons.  An open rhinoplasty involves one external incision on the columella and provides greater exposure during the surgery.  A closed (endonasal) rhinoplasty utilizes internal incisions.  Some surgeons only perform open or closed rhinoplasty while others utilize either approach depending upon the particular case.  Closed rhinoplasties have a higher revision rate.  Open rhinoplasties are swollen for a bit longer.  The list goes on and on.  The approach truly is not important.  What's most important is the surgeon performing the rhinoplasty.  It should be a plastic surgeon or facial plastic surgeon that mainly performs rhinoplasty surgery.  Thanks for the question and best wishes.

New York Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

There is really no difference between closed and open rhinoplaty except a tiny incision outside the nose

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This was once a controversy. It's more about what each individual surgeon is comfortable with. For many primary rhinoplasties I can get equal results with open and closed so I choose closed. There are a number of situations when I choose open rhinoplasty, these are: very crooked nose, extremely large nose that needs the tip set back significantly and complex revision rhinoplasty. It's more about finding as surgeon who makes you comfortable, has the credentials and skills. Look at their before and afters then decide based on that and not if they do this tiny incision or not.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 136 reviews

Open vs Closed

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IT depends on the skill and the preference of the surgeon and sometimes the problem they are approaching. I have over 30 years of experience doing closed rhinoplasties and prefer doing it that way. I think it gives you a quicker recovery and avoids a scar that can be obvious.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Closed vs. Open Rhinoplasty?

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This is a great question, we can talk about the differences indefinitely without reaching a consensus on which one is superior. Actually when we go to national or international rhinoplasty meetings we still argue which technique is superior. To make a long story short there are two major factors that have to be considered: Patient's deformity and surgeon experience.
Patient deformity: I usually use the closed approach if the patient has a simple hump he/she wants addressed, otherwise I prefer the open approach whenever I'm planning on doing major work.
Surgeon experience: You find plastic surgeons who do 90% of their rhinoplasties closed others who do 90% open. If the surgeon is more comfortable with one technique more than the other, it is important to use that technique to provide superior results

Ahmad N. Saad, MD
San Diego Plastic Surgeon

Open Vs Closed Rhinoplasty

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Open and Closed Rhinoplasty procedures are two different methods that plastic surgeons reshape the nose,” says Dr. Ali. “Which one your surgeon uses will depend on the current shape of your nose, as well as the preference of your surgeon. Both types of surgery have advantages and disadvantages to them, so it is important you ask your surgeon which he or she is most comfortable with, and which is recommended for you.”
A closed rhinoplasty, also known as an endonasal rhinoplasty, leaves all of the incisions inside the nostrils. This is an advantage for the patient as no visible scars will be seen. However, there are some challenges to this type of procedure. The incisions in each nostril are disconnected, which can make it harder for the nasal skin to be repositioned.
Additionally, the incisions are very small, reducing visibility for the surgeon. This can make the surgery more difficult in complex nose jobs, such as changing the shape or position of the tip of the nose. However, this can be a great technique for bridge augmentation or minor refinements of the bridge. This procedure can also be used in correcting deviated septums, as long as there aren’t major cosmetic changes needed, as well.
An open rhinoplasty is also referred to as an external rhinoplasty. There are a few hidden, internal incisions, as well as an incision along the columella, the skin that attaches the right and left nostrils. This incision adds much greater visibility for the surgeon because it allows for the skin to be lifted back, allowing the surgeon better access to the structures of the nose.
An open procedure also allows for the cartilage of the nose to be less distorted during surgery, allowing the surgeon to see all aspects of the nasal cavity in a more undisturbed manner.
“While many patients may come to a consultation with a closed rhinoplasty in mind, it’s important to remember that the scar an open procedure will leave is tiny,” says Dr. Ali. “While I perform closed rhinoplasty procedures, it is hard to deny that better accuracy can come from an open procedure. The results would far outweigh a tiny scar. Open rhinoplasty has transformed how we are able to reshape noses, giving plastic surgeons better control and precision in treating more complex cases.”
When performed by a skilled and well-trained surgeon, such as Dr. Ali, an open rhinoplasty scar will heal excellently, making it practically invisible to the naked eye. Two layers of incisions will ensure the incision will close properly, allowing for healing that will make the incisions almost imperceptible to friends.

M. Azhar Ali, MD, FACS
Bloomfield Hills Plastic Surgeon
4.8 out of 5 stars 29 reviews

Closed vs. Open Rhinoplasty?

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The answer is if one surgeon gets optimal results with a closed technique and one gets it with open technique, you chose the surgeon whose results you like best. You don't chose the technique, the surgeon does.
That said, in over 40 years in practice I have never done an open rhinoplasty. It was not done when I trained. In 1975,  I went into practice with a board certified plastic surgeon who had about 38 years of  an almost exclusive rhinoplasty practice, and  worked another 12 years with me.  He also never, ever did an open rhinoplasty.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Open or closed approach; what is the difference?

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The open rhinoplasty approach involves making an access incision along the columella that allows access to the dorsum and the other nasal structures. The choice really is down to surgeon's preference and at the times the complexity of the work involved. I always use the 'inverted V incision' and I find that this works excellently. I always use the open approach as it allows excellent precision. The incision scar has never been a problem in my hands.

Hope this helps.


Open vs closed approach

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Some surgeons prefer open approaches and some prefer a closed approach. In most instances, I prefer an open approach to be able to better visualize all the structures that I want to treat.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Closed vs Open rhinoplasty

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This is a very common question and the answer is they are both acceptable and reasonable approaches to rhinoplasty,  Not one is better than the other one.  Each has many advantages and disadvantages. The truth is, it's not important.  The only thing that matters is look on line and look at hundreds of pictures and when you find a surgeon who's work you really like, I mean lots of their results, then do it however they feel comfortable doing. That is how they got the results you like.  Dont kill yourself trying to figure it out.  Find the doctor and he will tell you which he prefers

Hope that helps and good luck

Rady Rahban, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 140 reviews

Closed vs Open Rhinoplasty

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To simplify things, essentially an open rhinoplasty involves an incision along the columella of the nose.  This is not present in a closed rhinoplasty.  For nasal bridge refinement either approach will work.  When nasal tip refinement is needed frequently an open approach is used, although this will depend on your surgeon's experience and preference.  

Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 30 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.