Should I Have an Open or Closed Rhinoplasty?

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.