There are two approaches to nose surgery: open and closed. The main difference between the two methods is the type of incision the surgeon makes in the nose.
Closed rhinoplasty involves internal or endonasal incisions only, which means that there is no cut on the external surface of the nose. This makes close rhinoplasty a more delicate procedure that requires that the surgeon doing it have a high degree of expertise.
Open rhinoplasty, on the other hand, involves an incision across the columella, which is the soft tissue separating the nostrils. These external incisions allow the surgeon to lift the skin of the nose to have full control over the underlying structure of the nose including the bone and cartilage. This method allows for bigger modifications. It is noteworthy that if the patient needs to get his/her nose wings smaller or his/her nostril asymmetry corrected, the surgeon may need to make a separate type of incision around the nose wings (ala), no matter if the open or closed technique is used. In other words, making incisions in the fold between nose wings and cheeks isn’t a factor to categorize a rhinoplasty as ‘open’.
All in all, choosing the surgical technique depends on the needs of the patient and the preference of the surgeon. For example, in cases that the nose needs less change and the patient wants a more natural result, the surgeon usually does the surgery with the closed method, while in cases with more than one structural problem, the open approach is preferred.
For more information, please go to: Open rhinoplasty vs. closed rhinoplasty.