Open and closed rhinoplasty both work very well
There are many techniques and methods to shape the nose in cosmetic rhinoplasty. Textbooks have been written to describe the various concepts and ideas used by surgeons which have given patients predictable and stable rhinoplasty results.
Cosmetic surgeons in the US generally perform both open and closed rhinoplasty procedures and indeed in our practice we perform closed rhinoplasty about one third of the time. Excellent results can be had with either technique.
What is most important is that your surgeon see and understand the problem or change needed as you do. The type of approach should fit the needed changes. If one surgeon wishes to change the shape of the bone and the other does not you should understand why, and understand how this will affect the result.
Also you mention that one wishes to adjust the nostril, and the other does not. Computer imaging and simulation can solve some of the problems of perception and how a result will look.
At the very least you should carefully explore what “look” each is working toward as they each seem to perceive your needs differently. Make sure that the changes made are really “you”. (Peter E. Johnson, MD, Chicago Plastic Surgeon)
Open or Endonasal (“closed”) Rhinoplasty
Your final outcome will not depend on the approach (open or endonasal) but on the surgical “moves” employed by your rhinoplasty surgeon.
Pros and cons of these techniques are often stressed by each surgeon depending on his own preferences. Pick your surgeon depending on his experience and your comfort.
A couple of additional points: Narrowing of the nostrils (a.k.a. alar base reductions) should be performed cautiously because there are virtually irreversible. Although they may be appropriate for most ethnic noses (i.e. Asian and African-American), they are, in my opinion, infrequently required in Caucasians. Our thinking about alar base reduction has changed over the last 15 years.
Judging from the photo provided, you may have a slightly weak chin. It would be interesting to discuss benefits of a conservative chin enhancement with your rhinoplasty surgeon as this may further balance your facial profile. (Frank P. Fechner, MD, Worcester Facial Plastic Surgeon)
Rhinoplasty: Open Versus Closed Approach
Choosing your rhinoplasty surgeon is most important in the ultimate success of your operation. The approach to rhinoplasty whether open or closed should not be a deciding factor. (Michael A. Persky, MD, Encino Facial Plastic Surgeon)
The rhinoplasty surgeon is the key
The bottom line is that good results can be achieved with either approach, and it depends more on the surgeon and his judgement than on the approach. Pick your surgeon based on his level of expertise and if you feel he can get you the results you want, but whether he does it open or closed is less important in my opinion.
One final note – if your nostrils are to be narrowed, that scar is the same whether you do it open or closed, but those incisions heal very well. (Shahram Salemy, MD, FACS, Seattle Plastic Surgeon)
Surgeon Expertise is important in Rhinoplasty surgery.
I perform nearly all of my Rhinoplasty surgeries with an open approach; especially if there is tip work involved. It’s how I was trained, and this approach allows me to deliver predictable, natural results.
Some Rhinoplasty surgeons prefer a closed approach, and get great results so research your doctor carefully. You should go to an experienced Rhinoplasty surgeon, and view many photos of favorable results before proceeding. (Eric M. Joseph, MD, West Orange Facial Plastic Surgeon)
The most comfortable approach is the right approach!
I like what you simulated for your nose. Unfortunately, without a picture of what your nose looks like unaltered, it is difficult to make specific recommendations. I perform both open and closed rhinoplasty.
When I make a decision for one technique vs. another, it is based on the idea that I can deliver the patient’s surgical goals with that particular technique.
Each of your surgeons has a different plan for the way to approach your nose, but in the end, hopefully they are looking at your cosmetic desires as their goal.
In other words, it doesn’t matter what approach they use, as long as they can deliver the results you seek.
By the way, you could benefit from a chin augmentation, and may want to speak with your surgeons about that if it seems to bother you enough to remedy. (Manish H. Shah, MD, FACS, Denver Plastic Surgeon)
Open or closed rhinoplasty describes two types of exposure for the surgery, not what is actually done to change the appearance.
Both allow adjustments of all three aesthetic units of the nose-upper 1/3, middle1/3 and the tip.
I have been doing rhinoplasties for 30 years and now use the open approach almost exclusively.
I have found that asymmetries of anatomy are often discoverd by the open approach that would not have been anticipated by the closed method.
In the end, though, the approach is a matter of opinion. You should choose the surgeon that will give you the best result, regardless if he chooses one approach over the other.
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That is your problem. Make sure you do your research carefully. Ask to see perhaps the results of 10 patients that were done in a row. (Anyone can have a few good results if they do a lot of cases).
Rhinoplasty has a steep learning curve and predictably good results are usually accoomplished by few surgeons. I like video imaging to educate the patient and often times me as well. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
Approach is not the Key to Successful Outcomes
Every good surgeon has a comfort level with one approach or the other based on experience. I have the longest experience of any living surgeon in the US with external Rhinoplasty so my comfort level is with the open approach but others prefer the closed approach and there is nothing wrong with that.
On the other hand looking at your pictures at least from the only view provided I am not certain what you hope to accomplish with Rhinoplasty. I would have recommended a chin augmentation rather than Rhinoplasty if you were my patient.
The more projecting the chin the more projecting that a nose might be to have a “normal” appearance. I see at least 3 or 4 patients per year who come in for Rhinoplasty because they think that is what they do not like about their appearance and they actually have the chin procedure instead. I always use extended anatomic silastic implants. Perhaps the frontal view would make me reconsider. (S. Randolph Waldman, MD, Lexington Facial Plastic Surgeon)
From your pictures you do not need rhinoplasty
There are different ways to achive a good result. In general open rhinoplasty is more predictable that closed. From limited view of your nose, I would not recommend rhinoplasty.
Your nose angle is very high already and if you rotate it any, it will look unnatural. Good luck and do not rush to get surgery(try computer imaging before surgeryto see if you will like the result) (Kamran Khoobehi, MD, New Orleans Plastic Surgeon)
Open versus closed rhinoplasty
The question of open versus closed rhinoplasty is even debated among the world’s rhinoplasty experts. There is not a correct answer and one answer is the the same for each patient.
It all really depends on your anatomy and your surgeon’s preference and training for surgery. (David Shafer, MD, New York Plastic Surgeon)
Open vs Closed approach to Rhinoplasty
Its immaterial. Open and closed approaches are a personal preference of a physician. For a primary (first time) rhinoplasty either approach is equally good. It is more to do with the competence level of the surgeon than the approach. You should focus more on who is a better surgeon and who do you feel more comfortable with. (Tanveer Janjua, MD, Bedminster Facial Plastic Surgeon)
Closed versus open rhinoplasty
Whether closed versus open rhinoplasty is best for you depends on your examination. Closed involves incisions inside of your nose, while open requires a very small incision across your columella (bottom of your nose between your nostrils).
Both procedures are good when performed on the appropriate patients. (David Shafer, MD, New York Plastic Surgeon)
Open versus closed approach in rhinoplasty
The difference between an open and closed rhinoplasty is about a 1 cm incision on the columella of the nose.
But, the advantages to perform an open rhinoplasty over a closed in most cases is enormous. The ability to visualize all the structures easily and directly allows for precise adjustments.
Think of being a mechanic and not being able to lift the hood of the car to fix the engine? (Steven Wallach, MD, Manhattan Plastic Surgeon)
Difference Between Open And Closed approach Rhinoplasty
Technically the open procedure includes an incision in the skin between the the nostrils which is not present using the closed technique.
This incision heals with minimal, inconspicuous scarring. Many of us use both techniques, depending on the needs of each individual patient.
I use the open approach in more difficult noses, such as augmentation rhinoplasty and nasal revisions, which gives better access, more control, and therefore more predictable results. However pick the surgeon, not the technique. (Richard W. Fleming, MD, Beverly Hills Facial Plastic Surgeon)
Different incisions for rhinoplasty
Either a closed rhinoplasty (all incisions inside the nose) or an open rhinoplasty (incisions inside and one small one outside on the nasal skin) can give very nice results. The key is not so much the incision but the surgeon.
You should spend some time reviewing with him or her your goals, and if they feel they can meet those goals, then whether or not they do the procedure open or closed is not as critical. (Shahram Salemy, MD, FACS, Seattle Plastic Surgeon)
- Closed approach: The skin incisions are all made inside the nostril.
- Open approach: All skin incisions are inside the nostril except one.
This one is made on the columella, the center of the nasal tip where it meets the upper lip and is not easily visible. The approach is not as important as the technical skill of the surgeon. Do at least two consultations. Then go with your gut (Tanveer Janjua, MD, Bedminster Facial Plastic Surgeon)
Open vs. Closed rhinoplasty approach
I think this is a matter of training; I am of the old school. I am comfortable with the closed technique. Pick your surgeon and let him do what is comfortable to him. (James H. Fuller, MD, Fort Myers Facial Plastic Surgeon)
Difference between closed and open Rhinoplasty
The ONLY difference is a short incision placed across the columella (Latin – for small column – the vertical strip of skin running from the tip of the nose to the upper lip, separating the nostrils.
These incisions heal extremely well. While good rhinoplasty results may be obtained without this incision (IE open), this incisions enables simultaneous visualization without distortion of the whole nose and a variety of surgical techniques which are difficult when the nose is seen through one intranasal incision, then the other. For this reason, many nose surgeons are increasingly adopting the use of the open approach. (Peter A. Aldea, MD, New York Plastic Surgeon)
You need to choose a physician who you believe in and trust. Some do open and some closed – there is no right or wrong answer. I was trained in both ENT and Plastic surgery and do a lot of noses – thus I am comfortable doing most of my noses closed.
I save open for very difficult or nasal revisions. Most primaries by me are done closed. Make sure the physician you choose is experienced and you feel comfortable with – in other words – make sure they answer all of your questions and have shown you their work. (William B. Rosenblatt, MD, West Orange Facial Plastic Surgeon)
Open Rhinoplasty approach improves access to your underlying nasal structure of cartilage and bone.
I think the important question should be: “What do I need to do to get a great result from my Rhinoplasty surgery?” I use an open approach in the vast majority of Rhinoplasty surgeries. This is how I was trained, and my particular technique allows me to deliver consistent, natural results, with very high patient satisfaction. The scar in your columella heals very well to invisible in most people, so in my view, the scar is not a negative.
I do not think downtime is prolonged with this approach either. You should consult several board-certified, experienced Rhinoplasty surgeons with many favorable photos to help you decide what’s best for you. There are many excellent Rhinoplasty surgeons that get wonderful results with a closed approach. So I think the outcome, and your ultimate satisfaction are the most important goals. I’ve attached a link to my Rhinoplasty page for your perusal. (Eric M. Joseph, MD, Chicago Plastic Surgeon)
Open rhinoplasty is generally for more complex nose surgery
The difference between the two is that in open rhinoplasty there is a small external incision that crosses the columella ( the vertical structure that separates your right from your left nostril). Open rhinoplasty is generally used for more complicated rhinoplasty procedures because it is easier to visualize and subsequently more easily correct distorted anatomical structures. (Otto Joseph Placik, MD)