Is Open Or Closed Rhinoplasty More Common?
Most primary rhinoplasties can be done “closed”. This is when all incisions are placed inside the nose thus no visible scars are created.
“Open” rhinoplasty requires an incision underneath the columella which many patients complain about.
On very rare occasions, such as a difficult secondary or tertiary rhinoplasty, an open rhinoplasty may be a good option. It is very important to ask your surgeon if he or she will perform an open or closed rhinoplasty. (William Portuese, MD, Seattle Facial Plastic Surgeon)
The closed rhinoplasty is performed entirely through the nostrils, whereas the open rhinoplasty has an additional incision across the skin of the columella, which is the strip of skin dividing the nostrils.
Most plastic surgeons have a bias of one over the other usually based on their training and experience. I prefer the closed rhinoplasty and feel I have excellent visualization and get great results that way.
I also had extensive training in closed rhinoplasty, whereas nowadays, many surgeons only learn the open method.
That aside, the most important issue is not whether you choose one method versus the other but the skill and experience of the individual surgeon you choose.
You should choose the best surgeon in your estimation regardless of whether that surgeon prefers the open or closed technique. (Ronald J. Edelson, MD, San Diego Plastic Surgeon)
Depends on your nose
Closed or open rhinoplasty nose job
There are advantages and disadvantages to each technique. Some noses are better with closed techniques and others are better with open techniques.
Your surgeon should feel comfortable with both techniques and apply the best procedure for your nose based on your anatomy. (Anil R. Shah, MD, Chicago Facial Plastic Surgeon)
Choose the approach, in concert with your PS, which will optimize your results.
Like any other cosmetic surgery procedure there are variables which affect the outcome:
- patient factors;
- surgeon factors;
- disease factors.
Closed or open rhinoplasty surgery
Ask your surgeon which approach (s)/he is most conversant with and discuss why it is more appropriate, for your particular case. Some physicians are inflexible fans of one or the other. “Patient” factors include whether this is your first or third nasal reshaping, whether this is part of a complex multiple facial fracture or congenital anomaly, such as a cleft lip syndrome.
“Disease” factors can be summarized in the fact that rhinoplasty is considered among the most technically demanding procedures, not only because of its anatomical position but because of the inherent subtleties required. That being said, try to understand the surgical “flight plan” for your rhinoplasty, because better comprehension will empower you throughout your recovery and bolster your patience. (Lavinia K. Chong, MD, Orange County Plastic Surgeon)
Open or closed rhinoplasty
Closed or open rhinoplasty photos
They call that incision the most debated 5mm in plastic surgery. The reality is that the incision is tiny, placed in a location that nobody see’s it (except your puppy looking up at you from below) and the amount of anatomy that you can see is undisputably superior. Something to bear in mind is that not all rhinoplasties require that much visibility. If you only need a little work here or there, you may not need to open.
If much work needs to be done, then pulling your cartilage and tissues out through a nostril and reshaping under those circumstances doesn’t make sense (to me). I’d rather take the 5mm slit and look at everything as it stands in nature, not as it stands when you squeeze it through a nostril. Either way, have your board-certified plastic surgeon evaluate you and see what his suggestion and rationale are. (Ricardo A. Meade, MD, Dallas Plastic Surgeon)
Which type of noses surgery is better?
You should pick a surgeon that feels comfortable using BOTH techniques. If your surgeon is able to use both techniques you will get the best of all worlds.
The open technique differs from the closed or endo-nasal technique by a small incision that is made in the columella (the area between your nostrils).
I use the open technique for patients who have very thick skin, need a lot of tip work or have a revision(redo) nose to do. As always ask a lot of questions and see before and after pictures. (Carlos Wolf, MD, Miami Facial Plastic Surgeon)
Open vs closed approach for rhinoplasty
There really is no way to answer this question without seeing your particular nose and discussing with you the changes you want.
In general when the bridge is the only area to change, the closed approach is ideal. When the tip needs to be corrected the open approach is ideal.
These are just rules of thumb but not 100% rules. Your surgeon should be experienced and skilled in both techniques. (Jason B. Diamond, MD, Beverly Hills Facial Plastic Surgeon)
Open or closed approach Rhinoplasty
I have been performing nasal cosmetic surgery for over 35 years and in the beginning of my career the only game in town was the closed approached.
This approach refers to performing the entire procedure from within the nasal cavity. This meant that the surgeon gained access to the nasal structures, cartilage and bone, through incisions inside the nostrils.
Therefore, no telltale scars were produced on the outside of the nose a presumed major advantage of the closed approach. However, there were also some deficiencies with it particulary related to sculpting the cartilages that made up the tip of the nose. Working from inside out, the closed approach, made accurate visualization of these cartilages difficult. In addition, various types of cartilage grafts came into vogue for nasal tip refinement .
These grafts were difficult to manage through a closed approach. The development of the open approach provided a whole new perspective for restructuring the nasal tip cartilages and insetting cartilage grafts into the nasal tip.
This approach essentially allows the surgeon to peal the nasal skin off the underlying cartilage giving the surgeon unparalled top down view of these cartilages. However, it requires making an incision on the surface skin of the columellar, the structure that devides the nostrils, I must admit that I was hesitant to employ this approach for fear of the visible scar that would result.
I soon found that this scar heals emaculately and is virtually invisible in the overwhelming majority of cases. But better yet, my results for altering the nasal tip were far better than those of the closed approach. What does this all mean?
If one’s Rhinoplasty surgery requires any nasal tip refinement then the open approach is a must and well worth the resultant scar. If no tip work is required then the closed approach will satisfy the surgical needs. It is therefore best to find a surgeon versed in both the open or closed approach.
Then it will be up to that surgeon to decide which technique is best for you. (David A. Ross, MD, Chicago Plastic Surgeon)
Open or closed rhinoplasty
Both open and closed approaches are commonly used. There are advantages and disadvantages to each. The additional scar from an open approach is virtually invisible in just a few weeks. You should choose an experienced surgeon who you feel comfortable with and whose results are similar to what you want to achieve.
Let the surgeon decide which approach is best. You wouldn’t tell an artist how to paint your portrait, so don’t expect to tell a surgeon how to do your surgery. (Randy J. Buckspan, MD, Austin Plastic Surgeon)
In a closed rhinoplasty all incisions are made within the nose. With the open procedure an additional incision is made in the columella (the vertical structure between your nostrils at the base of the nose).
Most surgeons use both tecniques, choosing their approach based on their personal experience and the needs of each individual patient.
After 35 years, I prefer the open rhinoplasty for revision surgery and noses that require augmentation.
However, pick a surgeon based on results, not techniques. (Richard W. Fleming, MD, Beverly Hills Facial Plastic Surgeon)
Is open better than closed rhinoplasty?
The history behind the two techniques is the following; the closed approach is the classic and traditional way of performing rhinoplasty.
In the early 1070’s Dr Goodman from Toronto introduced the open approach to North America. Slowly it has become the accepted.
It gives the best possible exposure to the underlying structures of the nose. If you can see what you are doing you have a better chance of doing the best result.
It comes at a cost, which is the scar under your nose. Most of the time this isn’t really an issue. Here in Toronto, just about everyone uses this technique, unless the changes are very minimal. A surgeon should use the open approach unless he/she feels he/she can get the same result with the closed method. (Oakley Smith, MD, Miami Facial Plastic Surgeon)
An experienced, Board Certified Plastic Surgeon familiar with both Open and Closed Rhinoplasty can address your concerns. All incisions are located on the inside of the nose on closed rhinoplasties.
Open rhinoplasty involves an incision at the base of the columella and possibly in the crease of both nostrils. An experienced surgeon can advise you which technique will best achieve the results you desire. (Malcolm A. Lesavoy, MD, Encino Plastic Surgeon)
Both Open and Closed Rhinoplasty can yield excellent results, Trust Your Face to a Facial Plastic Surgeon
Both open and closed rhinoplasty can yield excellent results. You need to be evaluated by a surgeon who is comfortable with both techniques. Open rhinoplasty is often advocated for individuals with severe deformities, while closed rhinoplasty is generally reserved for less severe deformitities.
Visit with multiple surgeons who are board certified by The American Board of Facial Plastic and Reconstructive Surgery, The American Board of Cosmetic Surgery, or The American Board of Plastic Surgery. (Gregory Pippin, MD, Toronto Facial Plastic Surgeon)
Choosing the best rhinoplasty surgeon
An experienced rhinoplasty surgeon will perform both of these procedures comfortably. The choice depends on what we would like to acheive with your surgery. Meticulous repositioning of cartilage in the tip requires an open rhinoplasty, in my opinion. (Raffy Karamanoukian, MD, FACS, Richmond Facial Plastic Surgeon)
Open vs. Closed rhinoplasty
A good rhinoplasty surgeon should be proficient in both endonasal (“closed”) and external (“open”) approaches. The needs of the patient, cosmetic desires, and functional issues, among other things, can influence the decision to perform one technique over another.
The “debate” over the two approaches has been exaggerated in the media and on the Internet. Both techniques, if done properly on the correct patient, can produce excellent results. (Matthew Bridges, MD, Metairie Facial Plastic Surgeon)
Open versus closed rhinoplasty
Rhinoplasty is a popular and effective surgery to recontour the shape of your nose. An open rhinoplasty is performed when the skin of your nose is lifted off of the internal cartilage and bone framework. This provides the surgeon with excellent visualization of your structures and can help them create a consistent and beautiful result.
A close rhinoplasty does not involve lifting the skin off of the internal framework. Because of the better visualization with an open rhinoplasty technique, many surgeons consider this to be a safer procedure that will more consistently provided results we want, especially in complicated rhinoplasties (Pat Pazmino, MD, Miami Plastic Surgeon)
It is important to understand that the terms “open” or “closed’ only define the surgical approach.
They are both designed to accomplish the same thing with the only difference being a small incision across the lower nasal bridge (columella).
The decision about what approach to use is based on how much nasal tip work is required. If the case requires more sophisticated maneuvers and/or if the case is a revision Rhinoplasty, I will use the open approach.
The reason is that the anatomy and can be more clearly defined and the procedure tailored more carefully.
There is no sacrifice in result between either approach in the hands of an experienced Rhinoplasty Surgeon. (Stephen Prendiville, MD, Los Angeles Plastic Surgeon)
Open and closed rhinoplasty are two different techniques-neither is right or wrong!
Open and closed rhinoplasty are two different techniques to perform rhinoplasty. Shy away from surgeons that tell you only one is right and the other is wrong.
Older surgeons sometimes despised open rhinoplasty because it made one incision on the outside portion of the columella.
This one incision ALWAYS heals without problems if designed and closed correctly so it is completely a non-issue. In my hands, I perform closed rhinoplasty for simple things like improving tip definition or simply taking down a dorsum.
More complicated processes like taking down projection, addressing a crooked tip, etc are better addressed through an open approach where all the cartilages are visualized and easily manipulated. Therefore neither approach is correct or wrong. They’re just different. (Raghu Athre, MD, Houston Facial Plastic Surgeon)
Closed or open rhinoplasty
It doesn’t matter ! You should choose a doctor that you are comfortable with and has demonstrated to you that he is an experienced rhinoplasty surgeon. He will, in his hands, perform the surgery using the technique that he thinks will give you the best result. (Andres Bustillo, MD, FACS, Miami Facial Plastic Surgeon)
Open or closed rhinoplasty: Let your surgeon decide.
The reason I say this is that the big difference between the two is a small incision on the underside of the nose (on the part called the columella). If done properly, this incision heals very well and is well-camouflaged. This should NOT dictate the approach. The approach should be dictated by the type of improvements the patient desires.
If no nasal tip work is needed, a closed approach can give a satisfying result. The closed approach can also be better for some revision work. However, when significant nasal tip work is required, the open approach is superior because the surgeon has a direct, undistorted view of the tip cartilages.
This ensures symmetric modifications and secure placement of cartilage grafts. (Anand D. Patel, MD, Brookfield Facial Plastic Surgeon)
Open or closed rhinoplasty approach
There is no one ‘correct’ rhinoplasty approach as either has a role depending on what your surgeon is trying to achieve. Also, some surgeons have extensive experience with one approach vs the other and solely use the approach that is their preference. Those surgeons, myself included, that focus on ensuring nasal stability via a structural enhancing approach (typically using cartilage grafts) tend to prefer the open approach overall. The very small staggered incision across the columella (the tissue separating the nostrils) heals very well and is typically very difficult to see once it is healed. The access to the nose (especially the nasal tip) allows for precise, symmetric changes while at the same time ensuring stable results and maintained (or improved) nasal airflow. If nasal structural integrity is not maintained initially good results can degrade after a few months or a year or more. Reviewing your potential surgeon’s photographic results (and finding out long postoperative they are) is the key. (Thomas A. Lamperti, MD, Fort Myers Facial Plastic Surgeon)