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

Open rhinoplasty and closed rhinoplasty (also known as endonasal rhinoplasty) are the two main approaches to rhinoplasty. Open and closed rhinoplasty refers to two distinct approaches of reshaping a nose.

open rhinoplasty vs. closed rhinoplasty

Open rhinoplasty vs. closed rhinoplasty

The main difference is that while open rhinoplasty refers to a procedure including an incision on the soft tissue between the nostrils (columella), the closed type addresses an almost similar treatment with all its incisions occurring inside the nostrils. Other important distinctions also define and distinguish the two procedures.

That said, you may not be able to figure out the real difference between the two approaches and the pros and cons of each one. Continue reading to find out the advantages and disadvantages of open and closed rhinoplasty methods.

Open rhinoplasty

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 for the operation.

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 what he is going to change and thus able to operate on the nose more delicately.
  • 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.
  • A very small scar might be visible on your nasal columella, though only when you tilt your head back.

Closed rhinoplasty

Closed rhinoplasty was the first method of nose surgery that was performed, 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.

What are the pros of closed rhinoplasty?

  • Closed rhinoplasty is less invasive and leaves no scarring and less swelling after surgery, so there will be a shorter recovery time and downtime.
  • A closed rhinoplasty procedure takes a shorter time to be completed than an open rhinoplasty.

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.
  • Closed rhinoplasty is not much suitable for people who want to get a lot of change in the soft tissues of their nose.
  • Incisions made in the nose weaken the nasal structure, undermining the stability of the shape of the nose in the future.

A study published in The Journal of Laryngology & Otology on the effectiveness of closed rhinoplasty approach for excision of nasal dermoids found that this method gives optimal cosmetic results in excision of small, superficial nasal dermoid cysts in well-selected cases and provides adequate exposure for total extirpation.

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.

That said, 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 are discussed and the best method for surgery is 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 a closed rhinoplasty.

Furthermore, many plastic surgeons remain adept at the closed technique, in particular in patients 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.

Open vs. closed rhinoplasty cost

Since closed rhinoplasty requires more skill and there are fewer surgeons who perform this procedure, it cost more than a typical open nose surgery. While the duration of an open rhinoplasty 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 nose surgeons often charge patients more for a closed rhinoplasty.

Frequently Asked Questions about Open and Closed Rhinoplasty

Is closed rhinoplasty safer than open?

In terms of safety, one approach isn’t necessarily safer than the other. Both are safe in the right hands, i.e. a well-trained and experienced surgeon.

Is closed rhinoplasty painful?

Both open and closed rhinoplasty is 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?

No, it’s not only not cheaper but some surgeons ask for more money for closed rhinoplasty because it is more demanding.

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 push 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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