Does an open or closed rhinoplasty yield more permanent results, prevent open roof deformity, & what are the pros/cons each?

Doctors agreed: only remove dorsal hump - conflicting consults w/open vs closed. Closed pros: no scar, no tip disruption, great pis of tricky closed nose job from closed recommending dr. (unsure of post-surgery date on pics). Closed cons: Bones can move/won't be stable structures if not cut in right place, bone above nose is a little narrow, may need graft post-op if it narrows. Open pros: more visibility to make exact cut/angle bone to prevent open roof deformity. Open con: scar; tip disrupt.

Doctor Answers 16

Open Versus Close Rhinoplasty

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There is no question that an open technique is superior. I did closed rhinoplasty for the first 10 years of my practice and have been doing mostly open rhinoplasties for the last 25 years because the result are more precise and more predictable. We do even see the tiny scar on the columella in most patients. It is extremely rare to have a rhinoplasty patient who only needs a hump removal only. Most patients have flaws in the tip or other sides that would make the open rhinoplasty more logical. Closed rhinoplasty is not wrong, it is less than ideal for most noses.

Cleveland Plastic Surgeon
4.7 out of 5 stars 23 reviews

Open or closed rhinoplasty.

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Both open and closed the results of rhinoplasty are permanent. There are textbooks and discussions at professional meetings debating the utility and benefits of each technique. Which is "best" for you will depend on the particlar changes needed for the results expected, and the particular experience of the your surgeon.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Limiting rhinoplasty surgery to hump removal may lead to droopiness of your tip postoperatively.

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In many patients, their dorsal hump may involve the lower cartilaginous bridge. When hump removal is performed with either an endonasal or an external approach, the supporting ligaments from your bridge to your tip cartilages may be severed. Maneuvers may be necessary to ensure your tip remains supported after hump removal to prevent tip droopiness postoperatively.

In general, the approach is less important than what is done to the underlying bone and cartilage of your nose during rhinoplasty surgery.

Feel free to re-ask your query with photos.

Hope this helps you.

Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 432 reviews


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ehhwhatsupdoc, wow that is a bunch of balony whomever is giving you information or perhaps you are simply reading something on the Internet. Whatever, doing an open approach leads to more supratip swelling which can particularly be a problem in patients with sebaceous skin. That is about it. I use the approach that best fits the anatomy and the patient; mostly closed. Let your surgoen decide; your job is to find an experieinced facial plastic specialsist with excellent photos. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 54 reviews

Open or closed

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You pick the surgeon and his/her results. Let the surgeon decide on the technique.
 Many older plastic surgeons mastered closed technique as that was the standard of care for decades.. Open technique was easier to teach, so the pendulum has swung to open rhinoplasty. I still believe that closed is better, in my hands.

Dennis Barek, MD (retired)
Great Neck Plastic Surgeon

Closed vs. Open Approach

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Thank you very much for your question.

As you can see, different surgeons will have different opinions regarding the approach.  I think the best approach is to find a doctor whose results you like, and in whom you have confidence to deliver the result you desire.  And then let them pick the closed vs. open technique.  Best of luck!

Open versus closed rhinoplasty

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 Continue to do your homework  because you are getting conflicting information. A closed versus open debate is only about the approach to get inside the nose, and has nothing to do with what is performed on the inside of the nose. The closed versus open debate is only about the incisions to gain access to the nose. A closed approach can accomplish advanced cartilage grafting techniques in the nose, osteotomies which prevent an open roof deformity, and can accomplish placement of spreader grafts and complicated dome suturing techniques. The dorsal hump is composed of bone bone and cartilage which must be shaved down in order to remove it. Osteotomies are performed with a closed approach to narrow the nasal bridge and close the open roof deformity. For many examples of dorsal hump removal  with closed rhinoplasty, please see the video and the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Open or closed? Doesn't matter.

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I won't even tell you what I prefer. Here's how you pick open vs. closed. First, you find a doctor who has great results working on noses like yours. If he passes all the tests about how to find a good rhinoplasty doctor that I list in the "Web reference" link below, then you've found your surgeon, and you let him do open or closed, whatever he thinks will work best for you in his hands!

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

Open versus closed rhinoplasty?

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Most of the rhinoplasty I perform are open. Over the years it's my opinion that this approach allows for better identification of the aesthetic problems particularly if there are unrecognized asymmetries. The disadvantage of more postoperative swelling of the nasal tip is acceptable in most cases in my opinion.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

Open or Closed Rhinoplasty

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The approach to Rhinoplasty can be open or closed, and the detail that separates them is a small incision in the columella.  I have performed hundreds of open Rhinoplasties and have yet to have a patient requesting a revision of a scar. The skin of the columella heals almost imperceptibly, so I wouldn't necessarily view this as a disadvantage.  I prefer to visualize the anatomy, so the majority of my rhinoplasties are open.  However, Rhinoplasty can be performed with equal proficiency using a closed technique in the right hands.  Choose the Surgeon, not the approach.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 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.