Would my closed primary lead to less scar tissue going into my revision than if I had had open surgery?

Hi I had a closed rhino surgery over a year ago and now am going for revision. Not sure if will be open or not, but prob open. Also, I have kind of thick skin. Would my closed rhino lead to less scar tissue to make my revision easier than if I had had an open surgery for my first rhino?

Doctor Answers 6

Closed vs open

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When the primary surgeon is doing the revision he or she knows what was done. When a new surgeon is asked to revise the nose we often find that open rhinoplasty affords a better view and gives more information than just an operative note.  I would expect your procedure should be and will be open

San Jose Plastic Surgeon
4.7 out of 5 stars 13 reviews


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A closed rhinoplasty rarely leaves less scaring, but your closed rhinoplasty may have led to your revision surgery. Be sure your surgeon is expert in revision rhinoplasty. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Would my closed primary lead to less scar tissue going into my revision than if I had had open surgery?

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Dear Sanfran103

The surgical approach (open vs closed) does not significantly impact scarring for revision. The surgical skill set of the primary surgeon, staying in the correct surgical layers and proper hemostasis are more important factors in scar tissue formation.  Look for an experienced surgeon who is properly trained and certified by the American Board of Plastic Surgery (or Facial). See more than one consult and make a well informed decision.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 58 reviews

Less Scar Tissue with Open vs Closed rhinoplasty

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There is no evidence that there is a difference in scarring when using the open vs closed rhinoplasty techniques other than  the small skin incision between the  nostrils. For significant revisions of rhinoplasty surgery done by other surgeons I usually recommend the open approach because exposure is better and the results more predictable.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Closed is always better when/if possible...but trust your surgeon

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Closed (scarless) is always better - even for revisions...but WHEN possible.  It isn't always possible to do a revision via a closed approach.  The problem is when surgeons do both open and closed rhinoplasty, they sometimes tend to lean on open approaches since it can be simpler/easier.

If closed can be done, it should be.  External scars (while rare to be problematic) can be problematic and if you are the rare case, it is always a shame. 

Consult a board certified Closed Rhinoplasty surgeon who performs rhinoplasty as 100% of his surgical practice. 

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 20 reviews

If theoretically same areas would be addressed, both techniques would leave the same amount of scar tissue...

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Thanks for your question. 

Truth is, both would create the same type of scar tissue if, in theory, the same areas would be addressed. What I consider pretty tough is to perform a secondary rhinoplasty with closed technique, as you do not know what the other surgeon did, and do not have the same field view as in the open approach. There's also the "semi-open" or "delivery" approach. 

To answer this best, I would tell you trust the technique your chosen surgeon dominates, in order to allow him to fix whatever needs to be revised in your case. 

Hope this answers your question, if not, feel free to contact me. 

Take care 

Dr. Fernandez Goico

Luis A. Fernandez Goico, MD
Dominican Republic Plastic Surgeon
4.9 out of 5 stars 145 reviews

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