How Do I Decide Between an Open Rhinoplasty or a Closed Rhinoplasty?

Rhinoplasty is more than a nose job performed by a plastic surgeon to alter the appearance and function of the nose on a patient’s face. It can also repair deviated septums and other breathing complications emanating from such medical issues like cleft palates, broken noses, previous rhinoplasties or tumors. Aesthetic, revisionist, and medically necessary repairs to the nose are done through either an open or a closed rhinoplasty.

According to the American Society of Plastic Surgeons, there are around 220,000 rhinoplasties done every year for many different reasons. It is the most common facial plastic surgery procedure to correct breathing and to give faces a more balanced appearance.

What’s the key difference between the two procedures? A closed rhinoplasty helps eliminate external scarring while an open rhinoplasty allows surgeons more direct access through the columella.

Open rhinoplasty (external approach)face by dr h_rhinoplasty procedure

Surgery utilizing the open rhinoplasty or external approach uses three incisions, one vertically on the right nostril, one vertically on the left nostril and a four to five millimeter incision connecting the two across the columella. These incisions open up the nasal skin (hence the name). This skin can be folded up so that the lower nasal skeleton can be directly seen without disturbing the interior alignment of the nose. This improves surgical accuracy, especially when dealing with more complex issues like cleft lip and revisions due to complications from past rhinoplasty procedures. Open rhinoplasty is performed under general anesthesia.

Will an open rhinoplasty leave a scar?

It is possible to have a small scar after an open rhinoplasty. However most scarring is imperceptible.

Advantages of open rhinoplasty

The greatest advantage of open rhinoplasty is that the surgeon has a direct visual of the nasal structure and cartilage. This creates better control and precision. Other advantages include:

  • It’s easier to work on revisions due to former surgeries
  • Incisions are underneath the nose
  • Nasal tips are more easily refined
  • Cartilage grafts are more easily placed

Disadvantages include a longer swelling time, more bruising, uncomfortable packing in the nose, a possible external scar, and longer surgery times, often 2 to 3 hours.

Closed rhinoplasty (endonasal approach)

Endonasal simply means inside or through the nose. Closed rhinoplasty is more complicated as the surgeon has limited visibility and is working with narrow incisions. However, it is less invasive than the open approach. Your surgeon would work through your nostrils. The skin and cartilage in the nose is raised so that the surgeon can reshape or repair your nose. Closed rhinoplasty is performed under general anesthesia and usually takes about two hours.

Advantages of closed rhinoplasty

Although both open and closed rhinoplasties share much of the same incisions, there are some distinct advantages to endonasal rhinoplasty:

  • Reduced postoperative swelling and bruising
  • Less pain
  • No visible scarring since incisions are internal
  • Shorter operative time
  • Quicker recovery time
  • Quicker return to normal appearance

There are cases where a surgeon may need to incorporate both the open and closed approaches to surgery. Septorhinoplasty, the repair of a deviated septum combined with cosmetic rhinoplasty is one such condition. The septum is the bone and cartilage that separates your right and left nostrils. Once the surgeon restores the septum to its proper functionality, the cosmetic procedure refines the nose shape, size and projection (how much a nose protrudes from a face.)

Frequently asked questions

During the consultation with your surgeon is the best time to ask specific questions regarding your surgeon’s approach regarding open and closed rhinoplasty. No matter what you are wanting to accomplish with your rhinoplasty, it all starts with the consultation. This meeting gives you the opportunity to discuss what you want resolved regarding your nose as well as your expectations regarding recovery and end results. During the consultation, your surgeon gather your medical history, take photos and perform a nose exam while speaking in-depth to you about your procedure.face by dr h_rhinoplasty

Professional questions you should ask your surgeon during the consultation include:

  • Are you certified by the American Board of Plastic Surgery and are you a member of the American Society of Plastic Surgeons?
  • Are you specifically trained as a plastic surgeon and how many years have you been one?
  • Are you more comfortable with open or closed rhinoplasty? Why?
  • Do you have hospital privileges? Get names.
  • Will the surgery be done within the office facility and how is it accredited to do so?

Questions you should ask regarding yourself:

  • What makes me a good candidate for an open procedure vs. a closed procedure (or visa-versa)?
  • What medications must be stopped before surgery and for how long?
  • How often will we meet before surgery and what will be accomplished during those meetings?
  • What do you expect of me prior to my surgery?
  • What kinds of risks and complications are there for an open rhinoplasty vs. a closed one?
  • If my surgery is in this office facility and I need to be transported to a hospital, do I have a choice of hospitals?
  • What kind of complications could there be regarding both the open and closed types of procedures?
  • What kind of recovery time follows immediately after the surgery and at home?
  • How long does a rhinoplasty take to heal completely? A few weeks, a few months, a year?
  • Will you be taking before and after photos?
  • Will you be using my photos for your web site or for marketing purposes?

These are a few of the questions you should ask your surgeon during the consult and any subsequent meetings before the day of your surgery. Jot down anything that you don’t understand so you can ask for clarification. It is also helpful to take someone with you to your consult so that two people are hearing the questions and answers.

All open and closed rhinoplasty procedures have their pros and cons. Deciding on plastic surgery can be a complex process since rhinoplasty is not simply for aesthetics, but also to fix functional issues regarding the nose. To learn more about your unique surgery needs, contact our office to set up a consultation.