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