What is a Closed Rhinoplasty?

What is this and what makes it different from other rhinoplasties?

Doctor Answers 27

The difference between open and closed rhinoplasty

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Closed rhinoplasty, also called endonasal rhinoplasty, involves incisions placed inside the nose. There are no visible external incisions in this approach. Open rhinoplasty, sometimes called external rhinoplasty, involves a tiny, inverted-V shaped incision being created in the columella, between the nostrils. If performed carefully and with attention to detail, this incision heals beautifully and nearly invisibly for the vast majority of patients. This approach allows the surgeon to see the tip (lower lateral) cartilages directly, in their natural shape and location, while reshaping them. The overall recovery experience is quite similar for both types of surgery, with the exception being that in the open approach, a handful of very fine stitches are removed 6-7 days after surgery. 

In my San Francisco Bay Area practice, I perform both open and closed rhinoplasty and it is the patient's nose and aesthetic desires which steer my decision regarding which approach to use. If there is significant work to be done at the tip, an open approach is preferable, in my experience. If it is simply a matter of shaving down a hump along the bridge or straightening a curved nose, these can easily be achieved through a closed approach. Let your surgeon guide you regarding which approach they prefer, based on your unique anatomy, aesthetic sense, and the surgeon's training and experience. 


Dr. Mehta

Closed Rhinoplasty

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Closed Rhinoplasty indicates that all incisions are made inside the nose, leaving no external scar.

Open Rhinoplasty offers the surgeon more direct visualization of the structural anatomy of the nose, but there is more prolonged swelling of the nasal tip.

There are equally expert surgeons who will choose one technique over the other. There is not one right answer: it is a matter of an expert's judgment and preference.

Closed vs open rhinoplasty

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Closed and open rhinoplasty are two different ways to do a rhinoplasty.  Neither is right or wrong, just different.  In a closed rhinoplasty, all the incision are inside the nose.  This might seem like this is advantageous.  However, you can imagine closed rhinoplasty like doing detail surgery through a tiny, dark hole.  Visualization is limited.  For simple things like taking off a simple hump or increasing tip definition, this method is preferable.  However, when you do complex manuevers like changing rotation, projection, fixing the septum, an open rhinoplasty is advantageous because visualization is much improved.  In an open rhinoplasty a small incision is made in the columella.  This incision ALWAYS heals without problems if designed well and closed carefully.  

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Closed rhinoplasty can avoid external scar

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Reshaping the nose using only internal incisions is referred to as "Closed".  This contrasts with an external incision.  The approach should be based on how best to correct the deformity present.  A surgeon should be competent in both techniques.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon

Rhinoplasty with no visible scars

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Closed rhinoplasty refers to the nasal surgery techniques where all the incisions are placed inside the nose, thus invisible, while open rhinoplasty has some visible incisions, even though they usually heal quite nicely.  There is a debate among nasal surgeons as to the pro's and con's of each approach. 

In my hands I get  best results using a closed technique, as I believe you can get some finesse in the tip than with the open approach.  As you probably have learned by now rhinoplasty is one of the more difficult procedures for a surgeon to master.  Whatever the approach, make sure your surgeon is able to create a beautiful nose with nice proportions. In my practice we offer computer imaging to our prospective rhinoplasty patients, so that the goals and aspirations of the patients can be communicated. Of course not all surgeons that can created changes on the computer can produce those changes in the operating room. Pick you rhinoplasty surgeon carefully.

You might find it insightful to read my article "The Art of Sculpting the Nose" which can be found on my web site under "publications"

Closed or Endonasal Rhinoplasty

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The “closed” or endonasal rhinoplasty is the classic way of performing this surgery, while the “open” or external rhinoplasty has been the technique of choice (including mine) for the past 20 or so years particularly amongst surgeons in practice less than 20 years and/or those who perform a lot of revision procedures. My personal reasons for preferring the external approach is the improved visualization and the fact it maintains more tip support mechanisms and attachments than the close technique. The only visible difference between these two procedures is the fine line incision that is made along the columella (bottom of the nose) with the external approach.

Closed Versus Open Rhinoplasty

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A "closed" rhinoplasty is really a misnomer because it would insinuate that no incisions are made.  In fact, a closed rhinoplasty still has incisions, they are just hidden on the inside.  A more proper name would be endonasal rhinoplasty which means through the inside. 

An "open" rhinoplasty has a single visible incision which goes across the columella (the thin piece of skin between your nostrils).  The scar it leaves behind is quite innocuous but, none-the-less, is still a scar.

Which way the surgery is done will depend on a number of factors.  Speaking for myself, I prefer to do most rhinoplasties closed as I can typically accomplish everything I need to without that incision.  I do open rhinoplasties when there are particularly challenging problems with the lower part of the nose requiring multiple and complex grafts. 

Closed Rhinoplasty

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There are two approaches to rhinoplasty: open rhinoplasty and closed rhinoplasty. In closed rhinoplasty, all the incisision are placed on the inside of the nose and no external scars are visible. Open rhinoplasty uses the same incisions as closed rhinoplasty with the addition of a small incision across the undersurface of narrowest portion of the column of tissue between your nostrils. With time, this scar is virtually unrecognizable at conversational distances.

Many surgeons perform one or the other. However, most rhinoplasty specialists are skilled at both techniques will recommend the approach that they feel is most appropriate for you.

A closed rhinoplasty is a technique where all of the...

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A closed rhinoplasty is a technique where all of the incisions are placed inside the nose. There are no external incisions placed whatsoever. This is a very common technique that is used for both primary and revision nasal surgeries. Open rhinoplasty technique is only used for the most difficult revision rhinoplasty surgeries where very extensive cartilage grafting techniques must be used to reconstruct the nose.

Defining Rhinoplasty

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Rhinoplasty has been categorized into two main techniques: Closed and Open.

Closed Rhinoplasty

In the most basic sense closed Rhinoplasty (also referred to as minimal incision or incisionless) uses only hidden incisions inside the nose. Most, but not all ,surgical techniques are possible with this approach. It is the oldest of the two techniques, dating back over 50 years.

Open Rhinoplasty

Open Rhinoplasty means that a small incision is made at the base of the nose in the columella. This is the area that separates the two nostrils from each other. As a result, less incisions are made on the inside of the nose. Although this cut usually heals extremely well and can not be seen easily, there are times when the scar is visible. This technique has been around for a long time as well; about 30 years.

Choosing between Closed and Open Rhinoplasty Techniques

The choice between these two techniqes, for me, rests in how much grafting is needed in a particular patient. Because open rhinoplasty gives the surgeon increased visualization of the underlying nasal structures, it is often easier to place grafts and permanent sutures in order to restructure the nose. This can be a blessing if the nose requires extensive work with multiple grafts, such as in revision cases, or, for some surgeons, extreme nasal deviation.

However, this increased exposure does come at a certain price. Besides the potential for a visible incision, there is often increased swelling of the nasal tip and, potentially, an increase in the risk of long term skin changes.

I use predominantly closed rhinoplasty techniques (over 95%) for primary surgeries, deviated nose correction, and selected revision cases. I try to use as few grafts as possible, as they ultimately increase the complication rate. More importantly, I find that my results are more natural with this approach. The operation tends to focus on remodeling the nose, rather than restructuring it.

With all this in mind, the exact same operation and outcome can be achieved with either of these techniques. Each surgeon has a particular preference, based on comfort and experience, for using one technique versus another. In the end, if you like a surgeon's results and feel comfortable with him or her, then you will most likely be happy with the outcome of either technique.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.