Key facts:

  • Open rhinoplasty involves an external incision in the columella, whereas there is no external incision in closed rhinoplasty.
  • Open rhinoplasty leaves a scar on the columella (the bridge between the nostrils), but no visible scars are left after closed rhinoplasty.
  • In open rhinoplasty, the nasal skin is lifted during the operation and the surgeon has good control over and access to the nasal structure, whereas the skin is not lifted in closed rhinoplasty, hence the limited visibility and maneuverability.
  • Open rhinoplasty is the preferred method for patients who need extensive modification to their nose.
  • Closed rhinoplasty is suitable for those who need small changes to their nose and want to heal faster.
  • Most surgeons are better at performing rhinoplasty with the open approach, while some may be better at closed rhinoplasty.
  • Closed rhinoplasty takes a shorter time than the open approach.
  • Recovery and healing are faster in closed rhinoplasty than open rhinoplasty.

Introduction

People decide to undergo rhinoplasty for different reasons. Some want to correct their deviated septum, which is making their breathing difficult, some just don’t like the small hump of the nasal bridge, and others might want a fundamental transformation.

If you have weighed up everything and made up your mind to go under the knife and get a nose job for whatever reason, chances are you’ve heard the terms ‘open rhinoplasty’ and ‘closed rhinoplasty’ while you were gathering information about the nose job procedure.

Open rhinoplasty and closed rhinoplasty (also known as endonasal rhinoplasty or ‘scarless’ rhinoplasty) are the two main approaches to rhinoplasty. Open and closed rhinoplasty refers to two distinct techniques of operating on a nose.

Closed rhinoplasty was the first method of nose surgery, which is still being widely used by many surgeons. In this procedure, small incisions are made inside the nostrils and the surgeon makes alterations to the nose through the nostrils without lifting back the skin. With the advancement of surgical techniques, however, open rhinoplasty is more widely used nowadays.

open rhinoplasty vs. closed rhinoplasty

Open rhinoplasty vs. closed rhinoplasty

The main difference is that while open rhinoplasty is a type of nose surgery for fixing the functional or aesthetic problems of the nose performed by making an incision on the soft tissue between the nostrils (columella) and lifting back the nasal skin, closed rhinoplasty is performed for the same purpose but with all the incisions made inside the nostrils without the nasal skin being lifted back.

That said, closed and open rhinoplasty methods are different in several other ways and have their own pros and cons. Continue reading to find out the advantages and disadvantages of open and closed rhinoplasty methods and whether you should go for the former or the latter.

Pros and cons of closed vs open rhinoplasty

What are the pros of open rhinoplasty?

Open rhinoplasty has some advantages over the closed approach, which are as follows.

  • Since the nasal structure is completely revealed, the surgeon has better access to the underlying structure and thus more freedom to reshape the nose as the patient desires.
  • The stabilization of the nose after surgery is easier in open rhinoplasty than closed rhinoplasty.
  • Most surgeons practice open rhinoplasty. Therefore, your chance to find a good surgeon for open rhinoplasty is greater.

What are the cons of open rhinoplasty?

The main drawbacks of open rhinoplasty are as follows:

  • Open rhinoplasty is lengthier and more invasive than closed rhinoplasty, so the recovery time will be a little longer and it takes more time for the swelling and bruising to disappear.
  • A very small scar might remain on your nasal columella, though only visible when you tilt your head back.

What are the pros of closed rhinoplasty?

  • Closed rhinoplasty is less invasive and leaves no scars and less swelling and bruising after surgery, so there will be a shorter recovery time and downtime.
  • Closed rhinoplasty procedure takes a shorter time to be completed that open rhinoplasty does.

What are the cons of closed rhinoplasty?

  • As there is limited visibility of the tissues and cartilage, the surgeon can make limited changes, with less delicacy.
  • There are fewer surgeons who are skillful at closed rhinoplasty than open rhinoplasty.
  • Incisions made in the nose weaken the nasal structure, undermining the stability of the shape of the nose in the future.
  • There is a higher chance of nasal cartilage distortion during the operation as accessing the nasal framework requires intense stretching of the skin.

How are open and closed rhinoplasty performed?

Before starting the operation, the surgical team administer anesthetic medications, which can be local or general depending on the surgeon’s recommendation. After the patient is put to sleep or the surgical site is numbed, the surgeon begins the surgery.

Simply put, in open rhinoplasty the surgeon makes a small external incision (called trans-columellar incision) outside the nose at the base of the columella (the soft bridge separating the nostrils). The surgeon then gently raises the skin of the nose, allowing easy access to the bony structure and cartilage of the nose for the operation.

After making the necessary changes to the nasal structure the surgeon closes the incision with sutures. Splints and gauze bandage will be applied in most cases, which should remain in place for a few days.

All the steps in performing closed rhinoplasty are the same as those in open rhinoplasty except that the incision is made inside the nose and the sutures used for closing the incision are absorbable (dissolvable), that is they will gradually dissolve on their own and won’t require removal. Also, the procedure takes a shorter time compared to open rhinoplasty.

Note: Sometimes a patient might want to get his/her nose wings (nasal ala) smaller or his/her nostril asymmetry corrected while he/she prefers the closed technique for reshaping the nasal tip and bridge. In this case, the surgeon may need to make a separate type of incision around the nose wings apart from the internal incisions.

Recovery time for open vs closed rhinoplasty

Since closed nose surgery is less invasive than the open method, there will be less swelling and bruising after this surgery and the the nose will heal faster. There might even be no bruising after closed rhinoplasty in some patients. Therefore, the recovery time in closed rhinoplasty is shorter than in open rhinoplasty and patients usually need a shorter time to be able to return to their normal life.

Open vs. closed rhinoplasty cost

Since closed rhinoplasty requires more skill and there are fewer surgeons who perform this procedure, it usually costs more than a typical open nose surgery. While the duration of an open nose procedure is longer than the closed method, the latter is a more complex and difficult procedure and is often frowned upon by surgeons. That is why some nose surgeons charge patients more for closed rhinoplasty. That said, some surgeons may charge a lower fee for closed rhinoplasty. You may contact AriaMedTour to get the updated prices for closed rhinoplasty and open rhinoplasty in Iran.

Open vs closed rhinoplasty in a nutshell

Open rhinoplasty Closed rhinoplasty
Suitable for Extensive changes Small changes
Procedure time Longer Shorter
Visualization (visibility of nasal structure during operation) Excellent Limited
Delicacy (difficulty of surgery) Less More
Recovery time Longer Shorter
Swelling and bruising More Less
Visible scar Only seen when you tilt back your head No

Should I have open or closed rhinoplasty?

As said above, open and closed rhinoplasty have their own advantages and disadvantages. With that in mind, depending on each individual’s circumstances and desired results, one of the methods is more suitable than the other.

Moreover, the skill of the surgeon in each of the techniques is a defining factor in going for one of them. During the pre-op consultation with your surgeon, all issues will be discussed and the best method for surgery will be decided.

In general, open rhinoplasty is suitable for any type of nose as there will be no limitation for the surgeon to operate on the nose. Open rhinoplasty is suitable for you if you want to get the size of your nose changed, have your dorsal hump removed, or get your nasal tip corrected. The open approach is especially good for those who are having a revision rhinoplasty.

On the other hand, those who want a small change to the nose, especially to the nasal bridge rather than the tip, and at the same time want to recover quickly with the least possible downtime, are good candidates for closed rhinoplasty, in particular, those that have quite straightforward nasal anatomy.

Meanwhile, open rhinoplasty has completely made great changes in treating complex nasal deformities including cleft-lip rhinoplasty, or severe post-rhinoplasty deformities.

It should be noted that many rhinoplasty experts believe that open rhinoplasty is the most suitable choice for difficult nasal anatomy of any type.

Feel free to contact AriaMedTour for a free consultation about whether you should have open or closed rhinoplasty. Our consultants are preperad to help you make the right choice.

Frequently Asked Questions About Open and Closed Rhinoplasty

Is closed rhinoplasty safer than open rhinoplasty?

In terms of safety, one approach isn’t necessarily safer than the other. Both are proven to be safe, particularly if they are done by a well-trained and experienced surgeon.

Is closed rhinoplasty painful?

Both open and closed rhinoplasty is usually performed under general anesthesia, so you won’t feel any pain during the operation. After the surgery, there would be some pain and discomfort in both methods which can be relieved by taking prescribed painkilling medications.

Is closed rhinoplasty cheaper than open?

It depends. Some surgeons charge higher fees for closed rhinoplasty because it is more delicate but others may charge a lower or equal fee.

Does close rhinoplasty leave a scar?

No, it doesn’t. There isn’t an external incision in closed rhinoplasty so there won’t be scarring.

Does open rhinoplasty leave a scar?

As an external incision is made to the columella, a small scar is left there. However, the scar is visible only when you tilt back your head so that your columella is exposed to view. Plus, the scar gradually fades away until it is hardly visible.

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