Rhinoplasty, AKA a nose job, is performed to make a change in the appearance of the nose. The procedure can be performed as open or closed rhinoplasty and it can change the shape, appearance and size of the nose. In addition, rhinoplasty can make functional changes to the nose and improve the ability of the patient to breathe on a daily basis.
As mentioned above, rhinoplasty can be performed as an open or close procedure. The decision regarding which technique to use depends on the desired final results, the amount or type of work that will need to be performed by the surgeon and how the underlying nasal skeleton impacts the final results the surgeon is trying to achieve. Cosmetic Town TV is often asked about the difference between the two techniques and we recently discussed this topic on our YouTube channel:
Once the decision is made to perform a closed rhinoplasty procedure, the surgeon prepares to make parallel incisions that encircle almost half of the lining of the nostril. These incisions give the doctor better access to the underlying bone structure of the nose.
Once the incisions are made, they are placed within the nostril which means the incisions, as well as any scars, are not visible since they are within the nostril. This makes the closed rhinoplasty technique much less invasive than open rhinoplasty and it also gives a patient a shorter recovery period after having the procedure.
It should be noted that there are a few limitations to closed rhinoplasty. The left and right nostril incisions remain disconnected after closed rhinoplasty is performed. This makes the repositioning of the nasal skin more difficult for the surgeon. The procedure is performed through separate narrow surgical openings so the doctor has limited visibility and limited access to the underlying structure of the nose. There is also an increased chance for nasal cartilage distortion due to the fact that accessing the nasal framework requires the doctor to perform a large amount of stretching of the skin. Finally, closed rhinoplasty does not allow the surgeon to perform complex reshaping or changes due to limited access to certain areas of the nose structure.
When the doctor performs open rhinoplasty, it means the surgeon is using an incision that can be described as a “bridging incision” that connects the incisions that are made inside the left and right nostrils. This incision is also known as a trans-columellar incision. The incision used in open rhinoplasty lets the surgeon fold the nasal skin back on the nose in order to gain unlimited visibility and access to the underlying nasal structure.
Since the surgeon has much easier access to the cartilage structure and the bone, this allows the doctor to enjoy improved accuracy and better contouring than what is available using a closed rhinoplasty technique. In addition, open rhinoplasty lessens the chances of nasal cartilage distortion and also facilitates the reshaping of the tip cartilage using more intricate grafting and contouring techniques.
The main limitation with open rhinoplasty is the fact that visible scarring is more likely. Thankfully, the scar is normally small (around 4-5mm) and the scar will only be visible at the narrowest part of the columella which is located on the undersurface of the nose. A board-certified surgeon that is skilled and experienced in performing open rhinoplasty can make sure the scar is small and barely visible.
When comparing the main difference between the two techniques, Dr. Deepak Dugar, a plastic surgeon with the Beverly Hills Rhinoplasty Center says “closed rhinoplasty is a technique where all the incisions are placed INSIDE the nose. For patients who absolutely cannot risk having a bad scar (which is very rare but always a risk), such as actresses, models, public figures or patients who keloid, closed scarless rhinoplasty remains the mainstay approach for sculpting their noses. Closed rhinoplasty used to be the preferred technique for the majority of rhinoplasty surgeons until the 1970s/1980s. This is the era where open rhinoplasty became more popular as it is easier to teach and allows more reconstructive techniques. Open rhinoplasty inflicts a small scar at the base of the nose to elevate the soft tissue envelope to better visualize the structures of the nose. The open technique is necessary for reconstructive and revision rhinoplasty but usually unnecessary (and definitely over-used) for MOST primary (never been operated on before) cosmetic rhinoplasty patients.”
When it comes to ideal candidates for either technique, Dr. Dugar says “Most primary cosmetic noses that need subtle refinement (as opposed to a drastic change) are ideal for closed rhinoplasty. However, many rhinoplasty surgeons don’t perform closed rhinoplasty and the ones who ‘dabble’ in it mostly perform open rhinoplasty and then do 5-10 closed rhinoplasty surgeries per year. This is dangerous as they truly don’t understand the anatomy from a closed perspective. Patients that desire, or need, closed rhinoplasty should seek a surgeon who does at least 200+ closed scarless rhinoplasty cases a year because this is a surgeon who truly understands the nasal anatomy from the inside.”
Dr. Dugar added “open rhinoplasty remains the gold standard for most surgeons as it’s the only technique they have been trained in. It is also the gold standard for any complex revision or reconstructive rhinoplasty. There are some overconfident closed rhinoplasty surgeons who like to do lots of revision cases with a closed approach but revision surgery SHOULD be done with a masterful open rhinoplasty surgeon. This is especially true in revision cases that are necessary due to significant scar tissue and warping of cartilages. There is a need for additional visualization that the open approach allows.”
While there are differences between the two techniques, there are just a few differences in the final results that make one technique stand out from the other. Without the creation of the columellar incision, closed rhinoplasty allows for the operation to be performed faster and also gives the patient less swelling after the procedure. However, open rhinoplasty lets the doctor reshape the nose with more precision thanks to the greater amount of access to the treated area.
According to Dr. Dugar, patients should meet with “an HONEST surgeon who will guide the patient in their BEST INTEREST and not just based on the surgeon’s best interest/capabilities.” The surgeon will examine the patient and discuss the results that the person wants to achieve. The doctor will also set realistic expectations so the patient will not be disappointed or surprised by the final results.
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