05 May Open vs. Closed Rhinoplasty – What is the REAL Difference?

When considering a rhinoplasty, one of the key distinctions that patients and surgeons make when planning rhinoplasty is whether to perform an open or closed procedure.  I get asked about these approaches a lot, so this blog post is meant to demystify what it really means to choose between open and closed rhinoplasty techniques.  Open rhinoplasty and closed rhinoplasty are both surgical techniques that can achieve excellent results, but they differ in several ways.

What is Open Rhinoplasty?

Open rhinoplasty is a surgical technique in which the surgeon makes a small incision on the columella, the narrow strip of tissue that separates the nostrils, and connects this incision to incisions made inside each nostril. This allows the surgeon to lift the skin and soft tissue off the underlying nasal structures, providing better visualization of the nasal anatomy.

What is Closed Rhinoplasty?

Closed rhinoplasty, also known as endonasal rhinoplasty, is a surgical technique in which the surgeon makes all incisions inside the nostrils, without any external incisions.  This approach is frequently described as less invasive than open rhinoplasty with a faster recovery time.; however, this is not necessarily true as I will discuss below.

Comparing Open vs. Closed Rhinoplasty

In surgery we talk about the concept of “exposure”.  This term refers to the view the surgeon has of the structures he or she is operating on.  Good exposure is a fundamental principle of good surgery.  The open rhinoplasty approach provides the gold standard exposure, where all the nasal structures are visible in their normal positions.  You can think of a closed approach as the surgeon using various windows to view the structures, but you never see all the structures all at once in their natural position.  This is truly the main difference between open and closed rhinoplasty.

The traditionally touted advantages of Open Rhinoplasty include better visualization of the nasal structures, allowing for more precise changes to the nose, allowing for a greater of grafting techniques with more precise placement, and an overall higher level of precision.  The disadvantages most surgeons discuss are primarily the scar across the columella, and a longer operation, recovery time, and a greater amount of postsurgical swelling.

Closed rhinoplasty advocates promote the shorter operative time and easier recovery, and a lack of the columellar scar.  Surgeons who are expert at closed rhinoplasty techniques are often able to accomplish many of the same techniques as open rhinoplasty surgeons, although certain more complex techniques required during difficult revision rhinoplasty cases are probably not possible using closed approaches.

Which Technique is Right for You?

In my opinion, essentially the only difference between the two approaches is the presence of a scar across the columella, except in complex cases where the open technique is universally preferred.  In general the swelling and recovery are actually essentially the same – for example, the classic bruising around the eyes is due to the nasal bone work that is done, and this is done the exact same way in the two techniques.  The columellar scar heals well for the most part and is actually very small – around 5 millimeters in length.

Given all this, the most important decision for patients is therefore what surgeon they go to.  Usually a surgeon does primarily open or primarily closed techniques, and has a strong preference for one technique over the other.  The question is not which approach they will use, but whether the surgeon’s aesthetics and techniques align with the outcome you are looking for with your surgery, and whether they have the experience to get you there.