Open Versus Closed Rhinoplasty

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Those who want to get a nose job in Los Angeles often get several consultations with plastic surgery surgeons who specialize in rhinoplasty. After many nose surgery consultations they often get confused about what type of rhinoplasty technique is best for them- Open versus Closed Rhinoplasty.

While many Facial Plastic Surgeons in Los Angeles prefer an open rhinoplasty procedure, many Beverly Hills Plastic Surgeons who specialize in rhinoplasty perform both open and closed rhinoplasty.

To decide which type of rhinoplasty is best, you need to first understand the differences between open and closed rhinoplasty. You also need to research the advantages and disadvantages of open and closed nose surgery.

inn-img-12With a closed rhinoplasty approach an intra-nasal or internal incision is made and the nasal skin is separated away from the underlying cartilaginous framework. Then the plastic surgeon looks through this incision and then shapes the nasal bone and cartilage. Because the nasal skin is not pulled back, the plastic surgeon has to be skilled in analyzing the contour of the nose by palpating the nose and by paying attention to subtle contour changes. Many of the techniques that are used to refine the nose through an open rhinoplasty technique are also modified for a closed rhinoplasty technique.

inn-img-16With an open rhinoplasty technique an incision is made on the lower part of the columella which extends into the nostrils. Then the skin of the nasal tip is lifted up thus exposing the underlying nasal cartilages including the alar cartilages, septum, and the nasal bridge or dorsum. This open nose surgery approach gives the facial plastic surgeon excellent visualization of the nasal framework as well as the ability to finely manipulating the nasal tip cartilage. It also makes it easy to introduce, place, and secure nasal cartilage grafts. Because of its improved visualization open rhinoplasty is utilized more often in revision rhinoplasty or redo nose surgery.

Open and Closed rhinoplasty has several advantages and disadvantages:

Table 1: Advantages & Disadvantages of Closed Rhinoplasty

Advantages of Closed Rhinoplasty Disadvantage of Closed Rhinoplasty
Shorter Surgery Time Requires more skillto refine nasal tip
Better Circulation to the nasal tip skin Requires more skill to perform Revision Rhinoplasty
Less nose swelling
Faster Recovery
Better for Nasal Implant placement

Table 2: Advantages & Disadvantages of Open Rhinoplasty

Advantages of Open Rhinoplasty Disadvantage of Open Rhinoplasty
Allows refinement of nasal tip in most difficult cases Prolonged swelling of the nose
Allows easy placement of cartilage graft Poor circulation to the nasal tip skin
Enables execution of complex maneuvers necessary for Revision Rhinoplasty Nasal skin incision scar over the columella
Easier approach for plastic surgeons Prolonged surgical time

  Less preferable for placement of Nasal Implants

While most senior plastic surgeons were originally trained in and are skilled with closed rhinoplasty many of the younger plastic surgeons have either not been trained in this technique or have not yet reached the level of experties to perform complicated closed rhinoplasty. Also, many Facial Plastic Surgeons usually favor Open Rhinoplasty because they have traditionally been taught nose surgery with the Open rhinoplasty technique due to its ease of visualization and teaching. As a Board Certified Plastic Surgeon who performs both the open and closed Rhinoplasty Techniques I try to customize my decision based on patients nasal characteristics, history of previous nasal surgery, and patients preference. Ultimately, I believe that a patient’s decision about rhinoplasty should not be focused on open vs. closed rhinoplasty technique, but rather on choosing a plastic surgeon that is best for them, regardless of which technique they use.