Refine Nose Tip with Closed Rhinoplasty?

Can the tip of the nose be refined with closed Rhinoplasty? Or does it have to be with an open Rhinoplatsy?

Doctor Answers 5

Refine Nose Tip with Closed Rhinoplasty?

Thank you for your question.

How the Rhinoplasty operation is performed?

There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

In the operation that needs the bone and cartilage tissues to be involved; open approach is used. In the procedures with open approach, the size, shape and functionality of the nose can be improved. The big nasal bumps can be removed and septal deviations can be corrected providing a better nasal airway.


Turkey Plastic Surgeon
4.9 out of 5 stars 79 reviews

Open Rhinoplasty vs. Closed Rhinoplasty

Tip refinement can be accomplished with both open and closed rhinoplasty techniques. The question of which surgical approach to rhinoplasty is the "best" -- Open versus Closed -- is one of the most frequently debated topics among Rhinoplasty Specialists.

Closed Rhinoplasty refers to a nose job that is performed via internal incisions - i.e., there are no external scars. The surgeon makes one or more incisions along the inside of the nose and lifts the skin up from the nasal framework. Once the skin is elevated, the shape of the nose is changed.

Advantages:

  • Potentially shorter operative time
  • Less swelling of the tip
  • No external scar

Open Rhinoplasty, on the other hand, uses the same incisions as a closed rhinoplasty with the addition of an incision on the undersurface of the column of tissue that separates the nostrils called the columella. While this places a small scar on the exterior of the nose, in most cases, the incision heals very well and is not noticeable at conversational distances.

Advantages:
Better visualization for the surgeon
Direct exposure of the anatomic structures
More precise intraoperative diagnosis
Less distortion of the nasal framework from intraoperative retraction
Ideal for complex nasal deformities

How do you know which approach is "best" for you? While you may have a preference for one or the other, your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon. Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs.

C. Spencer Cochran, MD
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 137 reviews

Approach is no longer much of a debate.

The short answer to your question is yes. A tip can often be refined through a closed approach, particularly if it's a primary rhinoplasty (meaning that it's not a revision surgery).

For years, surgeons used to debate whether open or closed rhinoplasty was "better" for reshaping the nose, especially in terms of tip work. But for the most part now, reasonable surgeons agree that the best approach is the one that works best in that surgeon's hands. Some can get beautiful results with the closed approach. I tend to prefer the open approach. The only surgeon I would fault is the one who claims that there is only one proper approach to the nose.

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Yes it is possible.

 The closed method has been used for 75 years for tip refinement. The open approach we popularized in the late 70's is used when you are dealing with major tip asymmetry and need to sew in grafts etc. The surgeon's skill should be the point, not the type of procedure. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

It depends on the nature of the problem...

 Depending on the complexity of the problem, a closed approach (endo-nasal) can be used for a tip rhinoplasty.  I there are large asymmetries or irregularities, an open approach may be better suited.

Ricardo Izquierdo, MD
Oak Brook Plastic Surgeon
4.0 out of 5 stars 8 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.