Mastering the Difference between Open and Closed Rhinoplasty

January 9, 2024 Dr. Philipp Franck

Surgical rhinoplasty, or nose job, is a popular cosmetic surgery that changes the shape or size of the nose. In fact, it is one of the most popular procedures in plastic surgery. Rhinoplasty surgery has long been considered one of the most challenging operations performed by surgeons, partly because of its dual role and central importance for both facial form and function.(1) When it comes down to rhinoplasty, you will often hear the term open or closed rhinoplasty. Understanding the difference between the two methods, the open technique and the closed technique can help you make the best decision for your desired outcome. In this blog post, I will dive into the details of open vs. closed rhinoplasty to help you determine which approach, open technique or closed technique, is right for you and if it really makes a difference.

What is closed rhinoplasty?

Closed rhinoplasty, also known as endonasal rhinoplasty, is a surgical method that involves making incisions inside the nostrils. This technique is less invasive than open rhinoplasty and is often preferred by surgeons for simpler cases where minimal changes are needed. Although it limits the surgeon's view and access to the nasal structures, some believe that it leads to a quicker recovery time. It also leaves no incision on the outside of the nose, so there is no visible scarring, unlike open rhinoplasty. For this reason, it is often referred to as a scarless nose job.

What is open rhinoplasty?

Open rhinoplasty is the most often used technique by surgeons worldwide. The main reason is that it allows a wider exposure and greater visibility of the nasal anatomy, making the open approach a little easier. In addition to the incisions on the inside of the nose, just as with the open approach, it also involves making a small incision on the outside of the nose along the columella (the narrow strip of tissue between the nostrils). This approach lets the surgeon lift the skin and soft tissue, exposing the cartilage and bone underneath. Open rhinoplasty is preferred in cases where the surgeon needs complete access to the nasal structures to make significant changes, such as for revision rhinoplasty or complex deformities.(2)

Benefits of Closed Rhinoplasty

One of the main benefits of closed rhinoplasty is that it leaves no visible scars since all incisions are concealed inside the nose. This can be particularly appealing for individuals who are concerned about potential scarring or want a more subtle change to their nose. In addition there is less dissection around the soft tissue of the tip of the nose leading to a quicker recovery period. By preserving the skin and soft tissue at the nasal tip closed rhinoplasty has recently gained a lot of popularity again with Preservation Rhinoplasty.(3)

Benefits of Open Rhinoplasty

One of the main advantages of open rhinoplasty is the ability to completely visualize and manipulate the structure of the nose, making it ideal for complex cases. In cases where extensive cartilage grafts or even rib grafts are used it might be necessary to have a wide exposure. It is very helpful in revision rhinoplasty. The scar tissue from prior surgery will make access to the nasal anatomy more difficult and possible hard to descern the different anatomy.

What do both procedures have in common:

Both open and closed rhinoplasty procedures have the same goal - to reshape and enhance the appearance of the nose. If you read this far you will probably understand by now that the difference between open and closed rhinoplasty mainly comes down to the incisions that are being made inside and outside the nose. The actual technique of manipulating the anatomy can be very similar between the too. For example both approaches can deal with a bony hump, a deviated septum, or a bulbous nasal tip. The cartilage framework of the nose is “delivered” through these small incisions within the nose and manipulated as required.

What are the disadvantages of either procedure?

While both open and closed rhinoplasty have their advantages, there are also some disadvantages to consider.

For closed rhinoplasty, one of the potential drawbacks is that it may not be suitable for more complex cases that require extensive reshaping or reconstruction. Since the surgeon has limited visibility and access to the nasal structures, it may be challenging to address certain deformities or achieve precise results.

On the other hand, open rhinoplasty does come with a small external scar at the base of the nose. In addition, there is more dissection of the outside skin layer involving blood vessels and soft tissue. Although the scar typically fades over time, it can still be a concern for some.

How long does it take to recover from open vs closed rhinoplasty?

Recovery time for open and closed rhinoplasty can vary depending on individual healing abilities and the extent of the procedure. Generally, closed rhinoplasty has a shorter recovery time of about 1-2 weeks, while open rhinoplasty may require a longer recovery period of 2-3 weeks.

Does the outside scar with open rhinoplasty look bad?

In most cases the scar is barely noticeable after it has fully healed. Luckily the columella is an area with good scar healing and because it is on the undersurface of the nose barely ever visible. In those very rare cases where the scar does not heal well or look unpleasing, there are variety of treatment options ranging from steroid injections, to lasers and more invasive alternatives such as a surgical scar revision.

Is there a difference in cost between open and rhinoplasty?

The cost of a surgical nose job can vary depending on factors such as the surgeon's experience, geographic location, and the complexity of the procedure. It is important to note that there should not be a difference in cost between an open or closed technique. However, there may be additional fees such as anesthesia and operating room fees. The complexity of your case and whether it's your first or a revision rhinoplasty will likely affect the cost. It is always best to consult with a qualified surgeon to receive an accurate estimate based on your specific needs and goals.

Which technique to choose?

When it comes to choosing between open and closed rhinoplasty, the decision will ultimately depend on your unique case and what your plastic surgeon recommends. Both procedures have their own advantages and disadvantages, so it is important to have a thorough consultation with your surgeon to understand which approach, whether open or closed, would be a better approach to achieve your desired results.

The most important thing to keep in mind when considering open versus closed rhinoplasty are your needs and the surgeon's experience. If the surgeon is only comfortable performing open rhinoplasty, he should not attempt to perform a closed approach and vice versa.

Closed rhinoplasty may be the preferred option for you if you are worried about an external scar. If you nasal anatomy however is complex or difficult or you already had a prior nose job you are likely a better candidate for an open rhinoplasty.

Difference between open and closed rhinoplasty takeaway for your personal consultation

The decision to undergo open or closed rhinoplasty depends on several personal and medical factors. Ultimately, you should base your choice on your individual needs, preferences, and goals. Consult with a qualified plastic surgeon to discuss the advantages and disadvantages of each technique and determine which option will provide you with the best results. By doing so, you can achieve a beautiful, natural-looking nose that enhances your facial features and boosts your self-confidence, including improved symmetry. Closed rhinoplasty is an excellent option for patients seeking subtle changes to their noses without the need for extensive reshaping.

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Philipp Franck M.D.