Torn between "open" and "closed" rhinoplasty - I'd like some opinions! (Photo)

I am 100% set on having a rhinoplasty. I am choosing between three surgeons currently. I would also like a lip lift done simultaneously, but with an open approach it's impossible - but I'm not choosing based on that. Is it possible to straighten a nose(leaning left slightly), reduce a (very) small dorsal hump and refine/narrow the tip through an open approach? I'll attach a picture of my nose. I'd favor a closed rhino but fear the results won't be as good.

Doctor Answers 16


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finallysophia, no one should answer your particular question based on your photos; not enough information. But I can tell you that I rarely open virgin noses; the exception being when they are over-projected but well rotated. For the rest I use a closed approach. Opening a nose leads to an increase incidence of post operative supratip edema which is rarely problematic in the long run but it at times can be. 
By the way dont' do your lip lift at the same time. Too much swelling that will make your scar heal less well; I always stage this.
Good luck; hope you choose a surgeon that is experienced and does "only faces".

Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Open Versus Closed Rhinoplasty

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It is the surgeon’s preference to do one or the other, both are excellent techniques. Open Rhinoplasty, in my opinion, is a better option. It provides you direct exposure to see the deformity and correct it. This should be done in the hands of a Board Certified Plastic Surgeon or Otolaryngologist with expertise in Rhinoplasty.


Rod J. Rohrich, MD
Dallas Plastic Surgeon

Torn Betweeen Open and Closed Rhinoplasty

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Torn between open and closed rhinoplasy. Hopefully you have consulted with 3 excellent experienced rhinoplasty surgeons who  can show you natural results in patients who had noses like yours. Despite what any surgeon in this forum says about these 2 techniques, pick the surgeon, not the procedure. 

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

closed rhinoplasty approach

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 A closed rhinoplasty approach is only about the approach, not what is accomplished on the inside of the nose. Osteotomies, hump reduction, advanced cartilage grafting techniques and suture techniques applied to the lower lateral cartilages of the nasal tip could all be performed with a closed rhinoplasty approach.  Choose your surgeon based on the end result, rather than which approach that they use. for many examples, please see the link and the video below  to our closed rhinoplasty photo  gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Open vs. closed rhinoplasty

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This really depends on your surgeon's preference. Great results can be obtained with either technique. I base my decision to perform one vs. the other on the complexity of the case. Feel free to watch my video for some examples and more information. Be sure the doctor you choose is a facial plastic surgeon or plastic surgeon. Good luck with your surgery!

Parker A. Velargo, MD
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

Torn between "open" and "closed" rhinoplasty - I'd like some opinions! (Photo)

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Your rhinoplasty surgeon should be experienced in both open and closed rhinoplasties. You should have a good result with either technique. There are advantages and disadvantages of both techniques. Discuss these with your surgeon and make an informed decision.

Warren J. Katz, MD
Dallas Facial Plastic Surgeon
4.8 out of 5 stars 19 reviews

Open vs Closed Rhinoplasty

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Every surgeon usually will have a preference as to the manner in which they like to perform a rhinoplasty. When I was in training 30 years ago it was very common to only do a closed technique. My personal approach has evolved into an open technique. I will still do a closed technique on a simple straight forward nose. If there is any significan tip work, I have found the open approach has alloweed me better control and better results. If there is any component of significant deviation, I prefer to open the nose. The scar at the columella with an open approach fades nicely. I would discuss with your board certified surgeon what they prefer. Be sure to go to someone with good experiance as well. 

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 27 reviews


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Hello and thank you for your question. This could be done with either open or closed technique.  Far more important than that, is that you find the right surgeon.  It is very important that you thoroughly research your surgeon before committing to surgery. It is a good idea to research your surgeon's educational background, online reviews, before & after pictures, and speak with anyone who you may know who has had surgery with that surgeon. During your consultation, make sure that you don't feel rushed and make sure that you have adequate time with your surgeon and not just their patient coordinator or nurses. If the majority of your consultation is spent with someone other than the surgeon, this is usually not a good sign. The most important aspect is to find a surgeon you are comfortable with.
Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews

Open vs close rhinoplasty.

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The main thing you should be concerned with is the outcome and choosing a surgeon. The difference between close and open rhinoplasty is a small incision over the columella which is barely visible after  a few weeks. The tip swelling is more with the open technique but that is a minor issue. The main concern is a long term outcome which should be pleasing and stable for many years not a few months. See consultation with a  Board certified Plastic or Facial Plastic surgeon.

M. Azhar Ali, MD, FACS
Bloomfield Hills Plastic Surgeon
4.9 out of 5 stars 31 reviews

Closed versus open rhinoplasty

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Generally, I recommend not to focus on the approach (external vs. endonasal, commonly referred to as "open" vs. "closed"). What is much more important to focus on is the end-result, both aesthetically and functionally. Some surgeons are better with open approaches, some with closed, some perform both. One cannot generalize that one approach is better than the other; it is very surgeon-dependent. With that said, an external (open) approach is generally more versatile as it can address essentially any problem in all cases (primary or revision surgery), and has a predictable and long-lasting result if done correctly. The same can be true for a well-done closed rhinoplasty, but not every patient is a candidate for a closed approach. The only negative difference between the two approaches is the tiny incision at the bottom of the nose with the open approach and slightly longer swelling of the nose postoperatively by a couple of weeks. Both these aspects are negligible since the scars heal so well that after a few months, they are essentially not visible at all any more. Furthermore, what is much more important than the slightly prolonged swelling of the nose are the long-term results, which are permanent, whereas the swelling is transient for a few weeks. In my experience, the benefits of an open rhinoplasty (more predictable and longer lasting aesthetic and functional result) far outweigh the disadvantages of the open approach. Choose a surgeon who you are comfortable with and whose results (as seen on before and after photos) you like most. Best wishes!

Thomas J. Walker, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

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.