Open versus closed rhinoplasty – More than Just Skin Deep
Open rhinoplasty and closed rhinoplasty are two approaches to reshaping the nasal tip. Open rhinoplasty means that there is an incision along the columella (soft tissue between the nostrils), while closed rhinoplasty means that all of the incisions are inside of the nostril. However, there are many more differences than just an incision and both approaches have pros and cons. How do you know what approach is right for you?
Open rhinoplasty has the distinct advantage of direct visualization of the cartilages. However, perhaps more important is the ability to manipulate and alter nasal shape with more control, precision, and even in ways not possible with closed rhinoplasty. Patients who need large amounts of projection (nose sticking out from face) or deprojection (pushing nose closer to face) are often better served with an open rhinoplasty.
Some nasal variants also warrant open rhinoplasty including cephalic oriented cartilages. Cartilages which are oriented to the top of the head rather than the ears (vertically oriented) will have weakness on the outside portion of the cartilage. With an endonasal approach, often times roundness is accentuated and patients develop pinching along the outside of their noses.
Closed rhinoplasty has the advantage of decreased operative time, less swelling and postoperative healing and avoidance of a scar along the columella. Many patients with closed rhinoplasty will have less swelling early on. In some patients with a minimal tip modification approach, patients will almost no nasal swelling by two weeks postoperatively. However, the goal of rhinoplasty is to shape the nose to the desired shape. Most patients will care more about their ultimate result than whether or not they had to contend with swelling.
The patient seeking rhinoplasty is best suited if his surgeon is able to perform closed and open rhinoplasty without bias. Closed rhinoplasty offers significant advantages in less downtime and swelling, while open rhinoplasty may be necessary in cases requiring increased structure or have variant nasal anatomy.