Revisionary Rhinoplasty for Semi-collapsed Nostril - Closed Rhinoplasty Method Possible?

The original surgery I had caused more feminization of the nose than I would have liked (I am male)and caused a semi-collapsed right nostril which appears somewhat noticeable to others. From what i've read here, the open rhinoplasty method is typically recommended for a collapsed nostril, however, I would like to know if this method is required for my case. I'd much prefer to avoid the scar (however faint)and the increased invasiveness that might occur with this method. Thanks, Tom

Doctor Answers 13

Closed rhinoplasty can solve all the same problems as open--with fewer risks

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Many surgeons have their preferred methods and reasons for them, but there is data to answer your question.

Patients that have had closed rhinoplasties have fewer and less severe deformities than those who have had open rhinoplasties.

This outcome is related to the open approach itself.  The only thing that the surgeon can see better in open rhinoplasty is the tip cartilages--and you and the surgeon pay a price for that visibility.  The open dissection decreases tip projection and creates many more opportunities for new deformities.

If you still have septum, it will be straightforward to raise your bridge a little and reduce the feminine appearance that you don't like.  Even if you don't have septum, placing ear cartilage along your alar rims to correct the concavities is easy, and ear cartilage makes particularly good alar cartilages because of its shape.

Find a surgeon experienced in closed rhinoplasty who can show you corrections of deformities like yours.

Nashua Plastic Surgeon

Semi collapsed nostril

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The approach of an open  reduction Rhinoplasty would be more likely to result in a better outcome

for your nose.

Open approach required

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The short answer to your question is no. There is no requirement for the type of approach, however each surgeon based on their experience will utilize the approach which maximizes the likely hood of a good result in their hands.

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Surgical approach for revision rhinoplasty

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In my opinion both open and closed approaches have their role depending on each patient's anatomy and goals. You have quite a bit of tip pinching and alar collapse. Often an open approach allows for the best reconstiution of the tip structure to help improve its appearance and function, but certainly some surgeons would recommend a closed approach instead.

What's most important in rhinoplasty cases isn't the surgical approach, per se, but what the surgeon does to the nose itself to make the necessary changes it its structure.

There are risks of unwanted changes after rhinoplasty (as you've seen). When done properly, the nose is supported such that post-operative loss of tip projection, etc shouldn't be an issue at all.


Very difficult Revision Rhinoplasty

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 I have performed Rhinoplasty for over 20 years and have performed some very difficult Revision Rhinoplasties, so you can put my comments in the proper perspective.  You have a very difficult nose to perform Revision Rhinoplasty upon.

  1. The tip cartilages were over resected using an older tip thinning technique were the cartilage is cut in two segments, the mid section remains and the outside segments collapse.
  2. There is a segment, on the right tip, where the skin is attached to the inside mucosa, of the nose, indicating there is no cartilage there at this time.
  3. The nasal bridge has been over resected creating a scooped out appearance
  4. There appears to be, a right sided nasal bone deflection creating a partial open roof deformity

 I perform both open and closed Rhinoplasty and use either to accomplish specific goals during Rhinoplasty or Revision RhinoplastyOpen Rhinoplasty is good for isolating the tip cartilages, so they can be sewn together, cartilage grafts can be glued in place all for increased symmetry, strength and shape for the nasal tip.  You really need a couple of in depth consultations to discuss your options which would be beyond the scope of this forum.

Hope this helps...IMHO, don't worry about the scar but rather focus on making your nose closer to what you'd like it to be.

Closed vs Open Revision Rhinoplasty

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You have more problems with your tip than just a collapsed nostril. I would recommend an open rhinoplasty, a technique I have used for 35 years for difficult revisions like yours. Having said that, some surgeons would use the closed technique. Pick the surgeon, not the technique

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Closed Technique is Possible

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Yes, closed rhinoplasty can be performed to well correct the nasal deformities that disturb you and compromise function.

More important though is finding the well experienced surgeon skilled to perform the reconstruction you require. Research carefully and ask to see before-and-after photographs showing the same or similar problems corrected properly.

The "right" technique in the "wrong" hands will not produce a satisfactory result. In this instance, the "right" technician and his/her best judgment is more critical to the mission than the (open vs. closed) technique.

Collapsed nostril; open or closed revision rhinoplasty

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Doing a revision rhinoplasty open or closed is not the issue; they are both only approaches; each has its drawbacks. You will find cultists who say their way is the only way to go. Your surgeon should know both approaches well and decide after examining you what is the best way to address your particular problem. The most important decision you should make is the choice of your surgeon to do the revision; how many of these has he done, what is his experience with your particular problem, can he show  you before and after photos of similar cases? In revision rhinoplasty, which is usually ten times more difficult than a primary rhinoplasty, experience and surgical skill are most important.

Everything is possible, but ...

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Everything is possible, including revising a collapsed nostril with a closed rhinoplasty.  However in order to maximize the possibility of a successful correction most surgeons would recommend that this be done open where the anatomy can be fully exposed and visualized.  This is especially important in the case of a revision because the anatomy has already been disturbed.  Scarring, previous grafts and realignments of cartilage from previous surgeries are better seen prior to making the necessary adjustments to correct a deformity.  During the closed method this is all done blindly.  

Revisionary Rhinoplasty for Semi-collapsed Nostril - Closed Rhinoplasty Method Possible?

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The open technique will allow better visualization of nasal structures and more percise corrective maneuvers. Having said that, closed techniques can also achieve relative improvements if done by a surgeon well-versed in revision rhinoplasty through close technique.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

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.