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

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. 

Hello,If you are a primary nose with no previous surgery, you should ONLY consider closed scarless rhinoplasty (preferred by actresses and celebrities) because there is no risk of external scarring and much less healing and recovery time.  The goal is to finesse and enhance the nose without drastic change.  Meaningful refinement is the key.   All the same surgical maneuvers your nose requires can be performed with a skilled closed scarless surgeon.  
Seek counsel with a board certified plastic surgeon who performs closed scarless rhinoplasty as 100% of his surgical practice so you know you can guarantee the expertise.  (aka don't get your nose done by a breast surgeon or a facelift surgeon).  Doing your nose the first time with the right surgeon is the key to avoid a botched or revision surgery in the future.  All the best!Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

Many reputable rhinoplasty surgeons use a closed approach and achieve favorable rhinoplasty outcomes. My rhinoplasty teacher started with endonasal, or closed rhinoplasty, and subsequently switched to open rhinoplasty in the 1980s when the approach was introduced and gained in popularity. I believe the majority of rhinoplasty surgeries performed now are with an open approach.We perform nearly exclusively open rhinoplasty surgeries for the reasons mentioned above. Hope this helps. Dr Joseph

The closed rhinoplasty is performed entirely through the nostrils, whereas the open rhinoplasty has an additional incision across the skin of the columella, which is the strip of skin dividing the nostrils. Most plastic surgeons have a bias of one over the other usually based on their training and experience. I prefer the closed rhinoplasty and feel I have excellent visualization and get great results that way. I also had extensive training in closed rhinoplasty, whereas nowadays, many surgeons only learn the open method. That aside, the most important issue is not whether you choose one method versus the other but the skill and experience of the individual surgeon you choose. You should choose the best surgeon in your estimation regardless of whether that surgeon prefers the open or closed technique.

In deciding open versus clsoed rhinoplasty, there is no "one size fits all" approach. In some instances, simple corrections are easily achieved with a closed approach and an open technique would be overkill with prolonged recovery. However, in more complex cases such as revision rhinoplasty there is no substitute for an open approach where complete exposure facilitates visualization for accurate placement of grafts. However, even some experts believe that a closed approach, in this case, permits a more intact blood supply and a "tighter" pocket to minimize graft displacement. This argument has gone back and forth for the past 100 years and will no doubt continue.   

I began doing all my noses closed but over time now do nearly all of them open.  I first used the open technique on cleft lip and palate noses.  Later I found that often times there are asymmetries in outwardly appearing symmetrical noses that can be unmasked with a blind closed rhinoplasty.  I think it takes longer for the tip swelling to subside with an open approach.  I do not think the scar is an issue.

It doesn't matter ! You should choose a doctor that you are comfortable with and has demonstrated to you that he is an experienced rhinoplasty surgeon. He will, in his hands, perform the surgery using the technique that he thinks will give you the best result. 

The reason I say this is that the big difference between the two is a small incision on the underside of the nose (on the part called the columella). If done properly, this incision heals very well and is well-camouflaged. This should NOT dictate the approach.

The approach should be dictated by the type of improvements the patient desires. If no nasal tip work is needed, a closed approach can give a satisfying result. The closed approach can also be better for some revision work. However, when significant nasal tip work is required, the open approach is superior because the surgeon has a direct, undistorted view of the tip cartilages. This ensures symmetric modifications and secure placement of cartilage grafts.

There is no one 'correct' rhinoplasty approach as either has a role depending on what your surgeon is trying to achieve. Also, some surgeons have extensive experience with one approach vs the other and solely use the approach that is their preference. Those surgeons, myself included, that focus on ensuring nasal stability via a structural enhancing approach (typically using cartilage grafts) tend to prefer the open approach overall.

The very small staggered incision across the columella (the tissue separating the nostrils) heals very well and is typically very difficult to see once it is healed. The access to the nose (especially the nasal tip) allows for precise, symmetric changes while at the same time ensuring stable results and maintained (or improved) nasal airflow. If nasal structural integrity is not maintained initially good results can degrade after a few months or a year or more. Reviewing your potential surgeon's photographic results (and finding out long postoperative they are) is the key.