What does an "open" and "close" surgery mean?

An open rhinoplasty makes an incision at the base of the nose in the visible skin strip between the nostrils as part of the surgical approach. A closed rhinoplasty only makes incisions inside your nose. The number of total incisions is more with closed Rhinoplasty, but nothing is visible to the patient. The approach is less important than what is actually done in the Rhinoplasty during the operation. That is what is most important.

Open leaves a scar on the columella and closed does not.Kenneth Hughes, MDBeverly Hills, CA...........

This used to be a source of controversy and disagreement.  Closed Rhinoplasty is the traditional approach to the nose, open Rhinoplasty became more popular in rte 90's. However, it isn't widely debated anymore with the exception of those Surgeons who promote "closed" Rhinoplasty as a healing advantage (it isn't).  The major difference between the two in terms of incisions is a incision across the columella (skin bridge between the nostrils), which heals beautifully.  The open approach offers better visualization of anatomy and is considered more valuable for complex tip work and revision cases.  Some Surgeons feel more comfortable with the open versus closed and vice versa.  I would focus your concerns on the quality and experience of the Surgeon in Rhinoplasty, which should far outweigh any concerns about approach.

Both approaches are acceptable.   For the first 10 years of my rhinoplasty practice I preferred the open approach for most noses.  Having performed rhinoplasty for almost 25 years I now believe the "closed "or "endonasal"  approach is a much less traumatic and predictable  approach in my hands.The incisions are illustrated in my book Rhinoplasty; Everything You Need to Know about Fixing and Shaping Your Nose available on Amazon

Hello and thank you for your question. Closed rhinoplasty involves incisions inside the nose. Open rhinoplasty involves a small incision under the nose on a portion of the nose called the columella. This incision usually heals perfect and is unnoticeable in 99% of patients. Either technique can be employed by your surgeon, depending on how much work your nose requires. The most important aspect is to let your surgeon explain which technique he/she is most comfortable with for your particular nose. With good surgical technique, you could have an outstanding result with either technique. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.Best wishes and good luck.

In the open procedure a small incision at the midpoint of the columella is made to help deglove the nose and expose the bone and cartilage.  This allows the surgeon wide access through which to manipulate the nasal framework and reshape your nose.  The closed approach uses incisions inside the nostrils to "deliver" the denuded tip for the surgeon to manipulate.  It obviates the need for a columellar incision although it affords less exposure.  In my opinion, the small columellar incision is visible after adequate healing so it should not be a key decision factor.  

The main difference between the two is about a 1 cm incision along the columella to allow for better visualization of the nasal structures.

 Open versus closed rhinoplasty is only the approach, not the actual surgical manipulation of the tissues inside the nose. A closed approach makes all incisions on the inside of the nose. An open approach makes incisions on the inside of the nose, and on the outside across the columella. Excellent results can be obtained with either technique. For many examples of closed rhinoplasty, please  see link below

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.

Your question involves the approach to the surgery that the surgeon takes.  An open rhinoplasty means that a small incision is placed on the columella of the nose, and this allows for better visualization during the surgery.  Often -- but not always -- an open approach is used in revision rhinoplasty.  A closed approach means that there is no incision.  The healing time can vary depending on the surgeon and his/her level of experience. In my own practice, the healing time is very similar. If you are having surgery this year, I urge you to discuss your questions with your surgeon.  We surgeons are here to answer all of your questions. You should never go into a surgery with lingering questions!