Which is Best: 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.
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.