Is Closed Rhinoplasty Better Than Open Rhinoplasty?

A rhinoplasty, or nose job, remains one of the most technically challenging plastic surgeries performed. The procedure requires meticulous attention to details, where mm of changes can mean difference between a good, great, or suboptimal result. Because the surgery is so precise, good exposure contributes to better diagnosis and ability to perform precise maneuvers. This is why the most popular approach to rhinoplasty is the open approach. This is where an incision is made in the columella and the nose is “opened” to obtain maximum exposure. Most surgeons today are trained in the open technique. However, with increasing demands for more minimally invasive options, one may ask if the closed approach is better.

The short answer is both are good, in the right circumstances. A closed approach is the original technique. Here, all the techniques are performed via incisions made on the inside of the nose. Tip cartilages can be delivered out into the open if tip work needs to be done. The advantage is much less swelling with a closed approach. Some may argue the result can be more natural than open, but I disagree. Whether a result is more natural does not depend on the approach used. One disadvantage of a closed approach is there is more limited exposure of the underlying nasal structures. This limited exposure also limits what surgical maneuvers can be done.

If your nose has just a hump, or you are looking for very minimal changes to your tip, than a closed approach can be a reasonable option. However, if more dramatic changes are required, if extensive advanced grafting is needed, then performing these moves and suturing are easier with the open approach. The main disadvantage is increased swelling and prolonged edema when compared to the closed approach. Another disadvantage is the scar, but fortunately these scars almost always heals very well that the scar is virtually invisible.

You will discover that the vast majority of surgeons today are trained in the open approach. It’s harder to find a surgeon who will perform closed approach for rhinoplasties that require tip work or extensive reconstruction. The main reason is not many of us are trained to deliver the tips for routine rhinoplasties. Vast majority of rhinoplasty teachers train surgeons using the open technique because of the great exposure. However, I do feel a closed approach is a good technique when a patient just has an isolated hump deformity that he or she wants taken down. In these cases, I don’t see a great need to open up the nose.

So, the answer to which approach is better is—both are good techniques. It really boils down to which technique reliably delivers the best results for the surgeon. More important than which exposure is better is how experienced is the rhinoplasty surgeon. I’ve seen great results from both experts who do only the open approach and experts who only do closed approach. You should not let the approach decision be the key factor in choosing a surgeon. After all, the number one most important goal is getting a good result. Suffering through a little more time with swelling and accepting a small scar are small price for getting a good result. Just bear in mind—as you’re researching surgeons—that if you prefer a closed approach, you’ll have less surgeons to find and consult.

For more information about rhinoplasties, or nose jobs, please visit our interactive website at www.dryuplasticsurgery.com. Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or info@dryuplasticsurgery.com.