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

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.

In the last 30 years, there has been a strong movement among experienced rhinoplasty surgeons towards open rhinoplasty, because of the advantages of correcting underlying asymmetries and making subtle refinements in shape or structure under direct vision. Open roof deformities should be rare with either closed or open rhinoplasty. I performed closed rhinoplasty exclusively early in my career, but over the last 20 years have evolved towards open rhinoplasty, which I now perform over 95% of the time, reserving closed rhinoplasties for patients in which I am making minimal or no changes to the tip. Nevertheless, there are still excellent surgeons who prefer closed rhinoplasties, and there is no one right way to do a rhinoplasty. The scars are virtually never an issue for the patients, and with meticulous dissection, tip swelling is a minor issue. I liken the analogy of an open rhinoplasty to opening the hood when working on the engine, versus working only from underneath. There is more that one can do, in terms of reshaping, with sutures and precise placement of grafts. Performing osteotomies can be done well through either approach, open or closed.

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

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!

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!

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.

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.

Both techniques can produce nice outcomes and your result will more likely depend on your surgeon and what technique they are comfortable with.  If just bony dorsum work needed then closed may be fine.  But most surgeons prefer the open technique as what the doctor can see in vastly improved.  The scar from an open technique is rarely ever a problem or noticeable.  Best to pick a doctor who does many rhinoplasties and let them decide what best.  Good luck.

Hello! External incision or closed is a decision based on the preference and experience of the surgeon. Dorsal humps and osteotomies (to prevent open roof deformities) can be done with either technique. If tip grafts or spreader grafts (to stabilize cartilage if a large dorsal hump is present) are needed they are often more precisely placed with an external incision. The most important key to success in rhinoplasty is not the incision but the experience and skill of the surgeon. Find a facial plastic surgeon who performs rhinoplasty on a routine basis, has plenty of before/after photos to show you and can morph your photos to show you expected results. Good luck!

Hello,This is a commonly asked question by patients.The debate between open versus closed rhinoplasty is an old and tired debate between surgeons. The conversation has now moved on simply because there are very good surgeons that commonly perform one, the other or both. In primary (first time) rhinoplasty , the approach to the nasal skeleton (open vs. closed) is not as important as what the surgeon actually does to the bone and cartilage. Neither of the approaches limits what can be done to these underlying structures in my opinion. I recommend making your decision not based on the open versus closed issue but based on the quality of before/after results and word of mouth.Regards,J. Phillip Garcia, M.D.