What are the implication of doing a closed vs open Rhinoplasty skin wise ?

I'm 39 years old, I intend to undergo a third revision rhinoplasty (it will be the fourth operation total). Does an open rhinoplasy causes more truma to the skin than a closed operation. Is a person with reddish nose skin, better have a closed operation in order to not worsen skin condition, the doctor with whom i consulted wants to operate with the open approach as he says that way he has greater control and better access to fix my nose.

Doctor Answers 10

You Will Need an Open Rhinoplasty

Having already had 3 rhinoplasties, you have a fair amount of scar tissue, and the only way to truly visualize the remaining cartilage and correct the structural problems is to do an open rhinoplasty. Closed rhinoplasty approaches for revisions can sometimes address a specific problem, such as a localized bump, but a closed procedure cannot possibly make significant changes in a predictable way. The relatively delicate cartilages are encased in a layer of scar tissue, which makes careful dissection and meticulous uncovering of the remaining cartilage essential. If the surgery is done carefully, the skin should not be at risk. Again, a meticulous dissection is necessary, staying at a level just over the cartilage to avoid thinning the skin.

Chicago Plastic Surgeon
4.8 out of 5 stars 95 reviews

Closed vs Open Rhinoplasty

I'm sorry you've had so much surgery trying to achieve the desired results. I understand your frustration but at this time I suggest you concentrate on selecting the best surgeon without trying to determine the best technique.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Open: much much better.

Especially for a fourth operation, I highly recommend the open approach. The skin doesn't do worse with open than it does with closed, so that's not an issue.

Why do you need a fourth operation? See the "Web reference" link, just below my response. It gives valuable information on making sure that your surgeon has given you a good evaluation and has the skill to work on your nose. You might want to peruse the rules there and make sure your surgeon fits the bill.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 reviews

Open rhinoplasty

In my opinion, an open rhinoplasty often gives better visualization.  Remember though, the skin elevated may be at more risk with each revision.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

An open or external rhinoplasty approach may allow your surgeon to have increased visibility and control with a nasal revision.

We use an open approach on nearly everyone requesting rhinoplasty surgery. A reddish nose could be related to rosacea, or your prior surgeries. The goal should be to get to a place where you are satisfied with your nasal appearance, so interview several rhinoplasty specialists so you could see what might be best for you moving forward.

Thank you.

Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

Closed versus open approach for revision rhinoplasty

  The closed versus open approach is only about placement of  the incision across the columella. A revision rhinoplasty can be accomplished with either closed or open approach, depending upon the surgeon's preference. Look for a very experienced rhinoplasty surgeon for best results, not about which technique they use

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Closed versus open

The risk of vascular injury or skin necrosis is higher with open approach in revision rhinoplasty.  However the excellent view it provides definitely helps in better control of all the grafts that her implant.  This is a very tough question to answer.  A person with reddish skin is no different than regular skin.  The most important thing is the comfort level of you surgeon with this approach.  If you surgeon feels comfortable that you will not have any issues then you should go ahead.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews


Hello and thank you for your question. For complex repeat revisional rhinoplasty, I generally prefer the open approach.  This will not have any adverse affects on the skin compared to the closed approach. The most important aspect is to find a surgeon you are comfortable with.  I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Open vs closed approach for revision rhinoplasty

For revision rhinoplasty primarily involving modification of the tip, it is generally best to perform through an external approach. This provides the best view for accurate analysis and surgical management of problems related to asymmetry, altering tip refinement, placement of grafts or other techniques to achieve the goals of surgery.  Closed rhinoplasty however would be appropriate if the revision is minor such as rasping of the bony dorsum or osteotomies without tip work.

J. Andrew Bartlett, MD, FRCS
Vancouver Facial Plastic Surgeon
4.1 out of 5 stars 16 reviews

Open and closed rhinoplasty have little difference in the way the skin heals, even with revision rhinoplasty

In revision rhinoplasty, there are often so many unknown things to deal with such as warped cartilage, unknown grafts, unusual twisting of bone and cartilage that an open approach gives more information to your surgeon. We also may get a more precise placement of grafts that we often use in revision rhinoplasty. The skin is not more at risk from either approach. Other than more information, the tiny incision across the bottom is the only real difference.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 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.