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The method chosen depends upon the severity of the deformity. In general, only minor, focal deformities are amenable to closed revisions while the majority will require an open approach. The open approach allows greater visibility and easier cartilage grafting.
Closed rhinoplasty has less tissue dissection and may have less swelling post op. The question is more what result you are looking for and if the surgeon feels comfortable that he can achieve that result with this approach. If he/she is more comfortable with an open approach and thinks it will be a more predictable result then follow his recommendation.
Whether a surgeon choses open or closed techniques for revision depends largely on the surgeon's, training, experience, and preference. The open approach allows for direct vision and easier placement of grafts. The closed approach has the advantage of disrupting less of the scar tissue and skin which may be helpful in certain instances. Another great option to consider is using dermafillers for revision rhinoplasty. Dermafillers are excellent at achieving excellent contour results. Non-surgical rhinoplasty techniques for revision also avoids much of the trauma and therefore some of the risks involved with revision rhinoplasty. The fillers last 6-9 months, but there is often a cumulative effect from having the skin supported over time. The results tend to last longer and longer and there are times when a permanent filler like ArteFill may be used.
Open vs Closed is a large argument between rhinoplastic surgeons. I do 95% of surgeries closed - but then again, I have been doing noses over 35 years. On occasion, I will do it open if it is very complicated, otherwise I do it closed.
The main advantage of a closed rhinoplasty is that recovery is a little quicker. However, after doing open rhinoplasty for 35 years, there are advantages to this technique in certain patients. In difficult or revision rhinoplasty procedures, the surgeon has more control and results are more predictable. I prefer the open procedure when grafts are necessary, when the patient presents with difficult tip problems, and with most revision surgery.
Closed Rhinoplasty heals quicker because it has less tissue dissection but the flip side is it also has less ability to deal with serious nasal tip asymmetries/deformities than Open Rhinoplasty.
The adavntage of the open technique is direct vision, precision, and the ability to suture stabilize the anatomy, grafts etc. Most rhinoplasty experts would advocate that most revisions be done open. There are some exceptions but that would be the most common approach I believe.
Personally, I do not think digital imaging is as constructive in a consultation as your impression of the Surgeon and examples of his/ her previous work. Digital imaging, even if a disclaimer is given, inevitably produces an implied result in a prospective patient's mind. Recent...
As long as the skin envelope has not been damaged, revision rhinoplasty is often safe even with multiple previous surgeries. Difficulty breathing with a drooping tip may be due to nasal valve collapse, and turbinate reduction surgery alone may not be adequate. Revising a nose with...
Without seeing pictures it is very difficult to advise you. I have had extensive experience and training in what we call 'tertiary rhinoplasty' which means patients who have had two or more rhinoplasties. When I am correcting a nose that has had two or more surgeries the root...