Which is Best: Open vs. Closed Rhinoplasty

By Cameron Craven, MD, FACS August 26, 2014 7 Comments

open vs closed rhinoplasty

A common question relating to rhinoplasty surgery has to do with the difference between open rhinoplasty and closed rhinoplasty. These are two varying surgical approaches used to expose the skeletal framework under the nasal skin. The surgeon’s choice between using open and closed rhinoplasty techniques depends upon how the underlying nasal skeleton affects the desired changes in shape and contour of the nose.

Closed (Endonasal) Rhinoplasty

When performing a closed rhinoplasty (endonasal rhinoplasty) the surgeon positions parallel incisions that encircle half of the nostril lining, thus providing access to the underlying bone structure.

The greatest benefit of closed rhinoplasty is that the incision (and subsequent scar) is made within the nostril and thus not visible. Because the closed approach is less invasive than open rhinoplasty, this technique also typically features a shorter recovery period.

However, in closed rhinoplasty the left and right nostril incisions remain disconnected, making repositioning of the nasal skin difficult. The entire operation is conducted through separate narrow surgical openings limiting visibility and surgical access to the underlying structure. Additionally, this approach carries an increased chance of nasal cartilage distortion as accessing the framework requires intense stretching of the skin.  It also does not allow complex reshaping of the tip to be readily performed.

Open (External) Rhinoplasty

Open rhinoplasty utilizes a “bridging” incision called a trans-columellar incision to connect the incisions made within the left and right nostril. This incision allows the surgeon to fold back the nasal skin giving unimpeded surgical access and visibility to the underlying nasal structure.

The ease of access to underlying bone and cartilage structure is the primary benefit of open rhinoplasty. This access results in improved accuracy when reshaping the framework; often enabling surgeons to achieve desired contouring that would not be possible using the closed technique. Additionally, open rhinoplasty minimizes the chances of nasal cartilage distortion and facilitates reshaping of the tip cartilages through intricate suturing or grafting techniques.

The downside to open rhinoplasty is that visible scarring is more likely. However, the scar is typically relatively small (4-5 mm) and occurs at the narrowest portion of the columella on the undersurface of the nose.  This way, with precise execution and closure, the scar should only be faintly visible.

Conclusion

Depending upon the patient’s natural anatomy and desired results, closed rhinoplasty can be a good option. In many cases, however, the improved accuracy and access of the open technique is a far greater benefit than the minor risk of visible scarring. In fact most rhinoplasty surgeons regard open rhinoplasty as the procedure of choice for difficult nasal anatomy of any type, and many of the most effective techniques of contemporary rhinoplasty can only be performed through the open approach.

Contact us to schedule a complimentary consultation if you are considering rhinoplasty.


Cameron Craven, MD, FACS

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.


7 Responses to “Which is Best: Open vs. Closed Rhinoplasty”

  1. Alyna says:

    I went with closed rhinoplasty surgery, I preferred it as there is no scars! Really happy with my results.

  2. Vivien says:

    Excellent blog post. Continue the good work!

  3. Joanne says:

    If the patient ONLY wants minor tip work (just slightly bulbous/uneven) do you think closed would be sufficient?

    • WD Staff WD Staff says:

      Hi Joanne,

      Thanks for submitting your excellent question! It is true that closed techniques are able to accomplish minor tip enhancement. However, all rhinoplasty procedures are patient-specific. So you would need to get an in-person assessment of your nasal characteristics to fully determine if its the right technique for your specific needs.

      I hope that helps!

      Thanks,
      WD Staff

  4. Leanne says:

    I only need my bridge to be straightened as a have a slight bump in my bridge but I’m happy with the contours of my nose, so is this possible with closed nose surgery?

    • WD Staff WD Staff says:

      Hi Leanne,

      Thanks for reading this post and submitting your great question. It does sound like a closed nose technique may work, however the only way to be sure would be to get an in-person consultation with a skilled plastic surgeon. If you are in the Austin area please give me a call! Otherwise make sure to do some research and choose a board certified surgeon who is in good standing with your state’s medical board and has tons of experience doing rhinoplasty.

      Hope that helps!

      Thanks,
      WD Staff

  5. Angela says:

    My brother is thinking of getting rhinoplasty to fix his crooked nose. Thanks for clarifying that a closed rhinoplasty does not leave visible scars. I think I will suggest to him that he should talk with a cosmetic surgeon first because he wants a shorter recovery period while getting assurance that his nose will be straightened out.

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