Open vs Closed Rhinoplasty

Many people interested in nasal surgery, or rhinoplasty, ask about the differences between “open” and “closed” rhinoplasty. These terms are used to describe the surgical approach to the nose. In open rhinoplasty a small incision is added to the “columella”, the bottom part of the nose between the two nostrils. By adding this incision the skin is able to be lifted completely up over the nose. This allows the surgeon to see all of the parts of the nose more clearly. I have found this to be very helpful in any case where the tip needs a good deal of reshaping or repositioning and in all secondary cases, when the patient is unhappy with previous results. The advantages are that it allows for more precision and helps to produce more predictable results. The disadvantages are really few but include the fact that the swelling takes a little longer to resolve and the potential to have a visible scar. In certain high risk patients, like smokers, diabetics and badly scarred noses, that the circulation to the tip of the nose might be bad and lead to skin loss. This should be very rare. I perform closed rhinoplasty in patients when the “basics” for a good result are already in place and not much needs to be done to the tip of the nose. Sometimes in secondary cases it is best to leave the skin in place and correct irregularities with small cartilage grafts placed in small spaces, also performed as a closed procedure. in summary, there is not really a right or wrong way to perform rhinoplasty. The best way is the way that your surgeon believes that he/she can get you the results that you want in the most predictable way possible. The rhinoplasty cost is no different between the two. Recovery of both types of rhinoplasty should be the same as well. Hope this helps.