Refine Nose Tip with Closed Rhinoplasty?

Hello,All the same surgical maneuvers your nose requires can be performed with a skilled closed scarless surgeon. We perform refinement of the nasal tip through a scarless approach using endonasal techniques to size, shape and positioning of the nasal tip cartilages. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

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.

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.

 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. 

 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.