Is the decision between an open and closed rhinoplasty really about the surgeon’s preference?

Two general types of rhinoplasty are the endonasal (“closed” rhinoplasty – all incisions hidden inside the nose) and the external (“open” rhinoplasty – all incisions EXCEPT one small incision are inside the nose.) In open rhinoplasty there is one small incision across the columella (the skin between the nostrils). This incision is generally extremely difficult to see, and is only about 3 mm (1/10th of an inch) long!

I perform both closed and open rhinoplasty. I have written a recent scientific article on this subject, entitled “Open Versus Closed Rhinoplasty.” Let me summarize the conclusions for you here: The decision on which technique to use depends on technical considerations with respect to the patient’s specific anatomy and his or her cosmetic requests, and also depends on physician experience with both techniques.

This patient had an open rhinoplasty 4 years ago. Look at his base view – see the incision?

The patient below had a closed rhinoplasty. His incisions were all on the inside of his nose:

In my experience, the closed approach is better for some noses, while the open technique is better for others. For example, in my practice the patient who requests simply a small hump removal may undergo endonasal rhinoplasty, while the patient with a severely twisted nose often requires – for technical reasons – an open approach for the best result. The approach I pick is based on what I think will provide the best outcome for you, and based upon our detailed discussion about the technical aspects of your procedure. The female patient shown here underwent an open approach because her nose was twisted and needed straightening. If she had only needed profile changes, I might have undertaken a closed approach. Can you tell that her surgery was open?!

Fortunately, there are no major disadvantages to either approach. However, each approach has special advantages for specific situations. Since every nose is different and has unique surgical requirements, I discuss the options with each patient and am happy to describe my surgical plan in detail.

Posted by Dr. Becker