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.