Should I Have an Open or Closed Rhinoplasty?

Let me begin by saying that I perform both open and closed rhinoplasty so there's no bias on my part towards one approach or the other. As you have heard from other surgeons on this post, the only significant difference between the two approaches is a tiny incision on the columella, between the nostrils. This incision heals nearly invisibly if created and sutured carefully. The healing of this incision has never been an issue for any of my patients.

My personal preference is to use the open approach in primary and revision rhinoplasty if there is significant work to be done on the tip of the nose. The open approach allows me to visualize these tip (lower lateral) cartilages directly and in a undistorted way while working on them. If the patient solely desires the removal of a hump or other work on the upper portion of the nose, then a closed approach is preferable. 

The take home point is that you should let your surgeon decide the approach that he/she feels is required to achieve the results you are seeking. Each surgeon's training and background is different and therefore the expertise with the open or closed approach varies. Make your decision based on your level of comfort with your surgeon, the before/after photos in the office/website, the surgeon's training/credentials, and the recommendations of other patients. 

Best regards,

Umang Mehta, MD

Open rhinoplasty has internal and external incisions, whereas closed rhinoplasty only has internal incisions inside the nose. The good news is that the external incision placed for open rhinoplasty is the columellar incision, which heals beautifully and is almost impossible to see. Open rhinoplasty gives the surgeon better access to the nose and is required for some maneuvers. Some surgeries can be achieved equally well through closed rhinoplasty, but the most important thing is that you do something that your surgeon is comfortable and confident in performing, as that is most likely to determine the final outcome. The columellar incision is not something to be worried about. I've never had any patient complain about it!
-David Mattos, Harvard-trained plastic surgeon

Rhinoplasty surgery can be performed through either an open or closed approach. With both of these techniques incisions are made on the inside of the nose along the nostril rim. When a closed approach is utilized no additional incisions are made. The surgeon is able to operate through these nostril incisions but doesn’t have direct visualization of the underlying anatomic structures. In contrast when an open approach is utilized a small incision is made across the columella that connects the two nostril incisions. This small incision tends to heal nicely and is almost imperceptible in most cases. This approach gives the surgeon the ability to lift the skin off the underlying bone and cartilage and directly visualize these anatomic structures.
                The approach utilized depends upon a variety of factors including the patient’s anatomy, aesthetic goals and the surgeon’s preference. Historically, the vast majority of rhinoplasties were performed with a closed technique.  This has gradually changed over the years and now most rhinoplasties are performed with an open approach. This is probably due to the fact that surgeons can more easily visualize the underlying anatomy when this approach is utilized.

                It’s important to understand that most surgeons utilize both approaches. Most surgeons agree that the surgical approach utilized is less important than the surgeon’s skill. For this reason, it’s important to consult a board certified rhinoplasty surgeon with experience in this area.