Tip Rhinoplasty - Open or Closed?

if you just want your tip worked on can it be performed as a closed rhino?and also this would be a revision all i want is the sutures my doctor placed in the first place to make my nose appear shorter out so it goes back to being long again, would it be possible to do this in a closed procedure?

Doctor Answers 10

Tip rhinoplasty can be performed with either open or closed approach

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Thanks for the question. It certainly may be possible to restore the length of your nose through a closed (endonasal) approach, but it would depend on what exactly was done during your primary rhinoplasty. In some cases, placement of a septocolumellar suture through a closed technique can change both tip projection (the degree to which your nose projects forward from your cheeks) and rotation (how upturned or downturned your nose is). For other patients, placement of small grafts around the tip or sutures in the tip cartilages can also change the length of the nose. If major revision tip work is required, an open approach may be more appropriate.

Photos would certainly be helpful in understanding the changes you would like in your nose. A complete assessment, however, would require examining your nose thoroughly, both inside and outside, as well as performing computer imaging during your consultation. 

By definition, this would be considered a revision rhinoplasty, as you have had a prior rhinoplasty. That being said, in some cases revision rhinoplasty can be quicker, less invasive and less costly than primary rhinoplasty. It really depends on the patient's particular concerns and the amount of time needed to address them. 

Kind Regards,

Dr. Mehta

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Tip revision - open or closed

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The approach depends on your surgeon's preference and complexity of your revision - typically the open approach allows for more options and advanced techniques

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Which approach to use for tip rhinoplasty

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Which approach to use for revision tip work really depends a lot on the specific situation and your surgeon's preference. There are certainly surgeons who would do a revision case like yours closed. I tend to prefer an open approach when doing revision tip surgery. In experienced hands the columellar incision heals very well. The access afforded by the open approach helps me ensure as much symmetry as possible while at the same time maximizing the structural support of your nose.

One thing to be aware of is that one can't presume that by just removing the previously placed sutures the tip will go back to where it was before your original surgery. There is often scar tissue in place that may prevent this. There are several other techniques that can be used to increase the nasal length, though.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Revision Rhinoplasty

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It may not be as simple as removing sutures to make the nose longer again.  I would suggest a consultation with an experienced revision rhinoplasty surgeon.  He or she can guide you as to what is possible and which approach works well in his or her hands to deliver the result you are seeking.

Anurag Agarwal, MD
Naples Facial Plastic Surgeon

Tip rhinoplasty can be done closed

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A tip plasty can easily be performed through a closed rhinoplasty technique. There is no need for open rhinoplasty, even if it is a revision. The tip needs to balance with the remainder of the nose before embarking on this type of partial rhinoplasty procedure.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Open vs Closed Tip Revision

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It is difficult to answer your question without pictures and a copy of the operative report from your inittial procedure. You continue to ask questions about revising a nose that none of us have seen. Rather than trying to do your nose by commitee, consult with an experienced surgeon to discuss alternatives and establish expectations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rhinoplasty revision

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Be careful. Removing the sutures alone may not return the nose to its presurgical condition. Remember there is a scar noe that is holding your nose not the stitches only.

Rhinoplasty can be performed as open or closed rhinoplasty, depending on your doctor's experience.

Lengthening the shortened nose is not an easy, simple procedure. consult 2-3 BOARD CERTIFIED PLASTIC SURGEONS( AMERICAN BOARD OF PLASTIC SURGERY) for second opinions

Samir Shureih, MD
Baltimore Plastic Surgeon

Nose, rhinoplasty revision open and closed

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I prefer a closed rhinoplasty because an open results in a scar as well as prolonged swelling and sometimes more scarring. You should be able to get your tip altered through a closed procedure. Watch my video!

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Open vs closed rhinoplasty

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If I plan on doing tip work, I usually perform the surgery open to get the best exposure and control of the tip sutures.  Yet, there are some surgeons who like to do the surgery closed.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Yes and no

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While pretty much most rhinoplasty techniques can be done open or closed, I want you to realize that "going back to your old nose" may not be realistic and many times its not simply removal of sutures because cartilage may have been removed and even if not, scar tissue may also be holding your nose in its new shorter shape.  Therefore, its probably not a matter of simply removing the sutures but having the ability to do whatever it takes, such as grafts, to add more length to your nose to make it RESEMBLE your old nose more.

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 119 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.