Open or Closed Rhinoplasty for Making Entire Nose Smaller?

Question

I would like to get my entire nose, from the base to the tip, made smaller by one cm. Would this require open rhinoplasty? I would personally prefer closed, for less healing time.

Philip S. Schoenfeld, MD, FACS · Answer

The approach your surgeon chooses with which to perform your rhinoplasty would be based on the surgeons comfort level with open or endonasal rhinoplasty in particular situations.  I use both approaches and continue to use open rhinoplasty in particularly difficult or revision noses.  In terms of healing, it may be that more difficult cases are performed with an open technique and the amount of steps used to complete the rhinoplasty has more to do with prolonged healing rather than if the rhinoplasty is performed open or using an endonasal approach.

Kevin M. Robertson, MD, FACS · Answer

Shun
I would agree with the others that have weighed in, specifically it is the skill and the preference of the surgeon that determines external vs endonasal rhinoplasty. And the issue of short term healing is relatively insignificant, since the focus is on a surgical result that will last a lifetime. And as all rhinoplasty surgeons will tell you, it takes a year or more for final results.
I want to bring up another point however. If you are truly decreasing your profile by a centimeter, that will take a long time for the skin/soft tissue envelope to contract down to the new structural height. In fact, that is likely to become the true limitation to your surgical result. That's a lot of change! Sometimes the skin does not have that kind of elasticity, or fails to show the defined qualities your surgeon created in the framework.  So you may be advised to keep a little more overall size, but improve the balance, which would give you a better shot at creating the definition and refinement of an appropriate result.

Eric M. Joseph, MD · Answer

The experience and preference of your surgeon should guide you in making this decision. I perform nearly all of my Rhinoplasty Surgeries with an open approach. Rhinoplasty Surgery rarely exceeds 2 hours, and downtime is only 10-14 days. By 3 weeks after surgery 90% of your swelling is gone, and it will be tough to tell that surgery was performed. Patient satisfaction is very high.
I prefer the open approach since visualization of your septum, bridge and tip is luxurious, and I feel it allows me to accurately reconstruct and modify these structures to obtain a desired result. 
I've attached a link to my Rhinoplasty photos for your perusal.
I hope this is helpful for you.

Michael A. Persky, MD · Answer

Hi Shun,
I hope that your nose is very large to start with because a 1 cm reduction "all around from base to tip" is quite a bit of trimming.
Skilled surgeons should be able to accomplish your goals with either approach, but for a large amount of reduction I prefer to use an open approach .
Choose your surgeon carefully, but not on the approach.
Good luck and be well.
Dr. P

Darrick E. Antell, MD, FACS · Answer

In my hands, the majority of the rhinoplasties can be performed closed, and I believe the recovery is quicker.

	While I do perform open rhinoplasties, they are reserved for special cases and have prolonged swelling.

Toby Mayer, MD · Answer

This is done either open or closed. The main consideration is the experience and ability of the surgeon, not the technique. See an experienced rhinoplasty surgeon and let him guide as to which is best in your case.

Steven J. Pearlman, MD, FACS · Answer

The choice of endonasal vs. open rhinoplasty really doesn't alter the ability to make a nose smaller. Some surgeons prefer endonasal, some open. I go about 90/10 endonasal depending on the anatomy. What is more important is the surgeons skill with either procedure. I suggest you seek a rhinoplasty specialist who you feel comfortable with, then go with their plan.

William Portuese, MD · Answer

A reduction rhinoplasty can be accomplished through either a closed or open rhinoplasty. It depends on the patient’s comfort and surgeon’s preference, but the amount of reduction rhinoplasty can be done through either open or closed. Open technique is just another technique that some surgeons feel more comfortable performing but it is the exact same procedure.

Sigmund L. Sattenspiel, MD · Answer

The preference for performing an open (external) rhinoplasty versus a closed (endonasal) rhinoplasty is determined by the experience and preference of each individual rhinoplasty surgeon. 
These are two approaches for doing the contour work that needs to be done. In my experience and in my hands, the closed or endonasal approach is far superior to the open or external rhinoplasty. I can achieve comparable, if not better, results with the endonasal approach. I reserve the open or external approach for a few select circumstances. 
The external rhinoplasty is a superb innovative and creative tool for me to have in my surgical armamentarium. However, in the vast majority of cases, I find that the external approach is unnecessary and may even be a detriment. 
Having said all of this, the most important factor remains the end results. With either approach, you will be living with the results of surgery for your lifetime.

Richard W. Fleming, MD (retired) · Answer

As other posters have stated, the choice between open or closed rhinoplasty depends on the experience and preference of your surgeon. Pick the surgeon, not the technique. Most experienced surgeons use both approaches; therefore rely on his/her recommendation.

Open or Closed Rhinoplasty for Making Entire Nose Smaller?

Answers (11)

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