Open or Closed Rhinoplasty for Nose Shape?

I have talked to two top doctors in my country for Rhinoplasty consultations. Doctor 1 proposes we do open plastic surgery; he will make my nostrils smaller, rotate my tip, and basically work only on the cartilage. Doctor 2 wants to do closed Rhinoplasty, work on my bone as well as the cartilage, and not modify my nostrils. My nose is not very big to begin with, it's just that I'm not happy with its shape.Which doctor should I choose? I've added a picture of how I'd like my nose to look after.

Doctor Answers 21

Open Versus Closed Rhinoplasty

The question of which surgical approach to rhinoplasty is the "best" -- Open versus Closed -- is one of the most frequently debated topics among Rhinoplasty Specialists. Unfortunately, there is not a simple answer to this question. However, gaining a better understanding of what is involved with each technique and becoming familiar with the advantages and potential disadvantages of each is the first step.

How do you know which approach is "best" for you? While you may have a preference for one or the other, your surgeon will recommend the approach that he or she feels is most appropriate, and the surgical technique employed depends primarily on the goals established by you and your surgeon. Some surgeons perform exclusively closed rhinoplasty while others prefer open rhinoplasty. There are surgeons who perform both types of rhinoplasty depending on the patient's needs.

Rhinoplasty is accomplished by removing excess bone and cartilage from beneath the skin covering the nose. In some cases, cartilage grafts are added to help reshape the nasal framework. After alteration of the supporting structures, the skin is repositioned over the newly shaped framework to give the nose its new appearance. The changes may be subtle or dramatic, depending on the needs of the patient.

Closed Rhinoplasty refers to a nose job that is performed via internal incisions - i.e., there are no external scars. The surgeon makes one or more incisions along the inside of the nose and lifts the skin up from the nasal framework. Once the skin is elevated, the shape of the nose is changed.

* Advantages:

  • Potentially shorter operative time
  • Less swelling of the tip
  • No external scar

Open Rhinoplasty, on the other hand, uses the same incisions as a closed rhinoplasty with the addition of an incision on the undersurface of the column of tissue that separates the nostrils called the columella. While this places a small scar on the exterior of the nose, in most cases, the incision heals very well and is not noticable at conversational distances.

* Advantages:

  • Better visualization for the surgeon
  • Direct exposure of the anatomic structures
  • MMore precise intraoperative diagnosis
  • Less distortion of the nasal framework from intraoperative retraction
  • Ideal for complex nasal deformities

Dallas Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Closed Rhinoplasty Tip Work

Normally a closed rhinoplasty tip work refers to the fact that upper and lower lateral cartilages, which are at the tip of the nose are too big or asymmetric and also the tip may be pulled down. All these referring to a boxy, round tip with possibly a decreased angle from the tip to the upper lip. In most cases people do have work on the upper and lower lateral cartilages and occasionaly need a stent to hold the tip up following this if the tip is pulled down, which is custom in a closed rhinoplasty.  

John S. Poser, MD
Gainesville Plastic Surgeon
3.8 out of 5 stars 11 reviews

Open Rhinoplasty vs. Closed Rhinoplasty

Proper assessment of your nose should be with pictures of the frontal profile, WEP, and side profile. It seems as though you will definitely require columellar work and tip work and in this detailed case, you would fair better with an open rhinoplasty with tip work.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Having a experienced surgeon who you trust is what matters

It is important to find a nasal surgeon who you believe in, trust and will give the results that you desire. It does not matter whether the nose is done open or closed; just look for someone who has lots of experience and has done thousands of rhinoplasties. Make sure you research the surgeon quite well as far as his credentials, background, training, experience, and look at plenty of before and after photos.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Which is Better - Open or Closed Rhinoplasty

Dear Bianca,

First, I'm glad the picture you posted is of your desired nose rather than your current nose. I looked at the picture before reading the text and I was thinking you had no reason to ask for a rhinoplasty! It would have been more helpful for you to send your current (unmodified) nose, so I would have a better idea of what you are starting with. The discussion of open vs. closed has been going on for years. I perform both techniques, and like to use the closed approach where the preoperative anatomy lends itself to a reliably good result. In some cases, even though it might technically be possible to approach via the closed technique, you would be pushing the technique to the limits, and the results become less predictable. In those cases, the open approach is more powerful. Some surgeons prefer only one technique, and you just have to judge the surgeon based on reputation / results, and go with what they want to do.

Dr. B

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

Depends on how much nasal tip work needs to be done

Over the last 25 years I have used both closed and open techniques. If I'm performing work on the septum, which is the cartilage between the two nostrils, or if I'm just smoothing the dorsal hump or narrowing bones, I will usually perform a closed rhinoplasty. If I'm doing more extensive work on the nasal tip, narrowing it, remodeling it, correcting deformities that require cartilage or bone grafts, I will do an open technique through a small incision in the collumela which is the skin that runs from the down to the base of the nose between the nostrils. This allows me direct vision so that I can get a better idea of the problem and corrected with more precision.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 20 reviews

Open vs Closed Rhinoplasty

First and most important you must decide what changes you want. I've used both the open and closed techniques for many years. Which technique is not nearly as important as the the surgeon who does your rhinoplasty. Pick the surgeon, not the method. Look carefully at their experience, their reputation, and their results.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews


 Without examining you and seeing more photos of you in different poses, makes it difficult to answer this question.  Open or closed, it depends upon the surgeon, However, I personally perform mostly open rhinoplasties because I feel it can give the most natural and precise result.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Open Rhinoplasty allows more accurate nasal tip modification and usually improves results

The best Rhinoplasty surgeons in the world can probaly get equal results with open or closed approach. However, today the open approach is more favored.

The open approach allows direct vision of the underlying cartilagenous structure which mean that they can more easily and accurately shaped to the new profile.

If what you mainly want is a better shaped tip, I would go with the open approach

April see before and after photos of Rhinoplasty.

Younger surgeons are more comfortable with open rhinoplasty.


Both rhinoplasty techniques are good. I personally use the open technique only when complicated tip work is necessary.

Each surgeon is most comfortable with a particular approach. So pick the surgeon you trust the most (Ask to see a lot of before and after pictures.), and let him or her do the operation they recommend.

The surgeon determines the result, not the specific operation. You can probably get a great result with either one.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 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.