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Closed Versus Open Rhinoplasty

Published on December 15, 2017 by Jonathan Pontell

One of the most confusing decisions when considering your rhinoplasty procedure is whether to choose an open or closed surgical approach. While this decision may sound daunting, closed and open rhinoplasty only refer to the different ways of accessing the nasal framework. Dr. Pontell performs both open and closed rhinoplasty, with the vast majority being open.

Closed Rhinoplasty

When rhinoplasty was first developed, the only option was to use a closed approach. In closed rhinoplasty, all of the incisions are made inside of the nose with no visible incisions on the outside.

Candidates

While many rhinoplasty patients are candidates for the closed approach, this approach is best suited for those whose surgery is less involved and focuses on the upper part of the nose or the removal of a nasal hump.

Benefits of the Closed Approach

Since all of the incisions are made inside the nostrils, the closed approach lends itself to a slightly shorter operating time.

Difficulties of the Closed Approach

With closed rhinoplasty, there is a lack of surgical access and exposure. Your surgeon has to use his knowledge and expertise to very carefully separate the layers of skin and cartilage to perform the surgery. It is much more difficult to do the more sophisticated parts of rhinoplasty that are routinely done with the open approach.

Open Rhinoplasty

Open rhinoplasty differs in that it makes a small incision across the columella, which is the soft tissue and skin between the nostrils. This additional incision allows for greater access and sight lines to the nasal framework.

Candidates

Dr. Pontell often uses the open approach with his patients. Patients who desire alterations to the nasal tip and projection changes are best suited for this technique. Revision rhinoplasty patients are almost always done using the open approach, as these cases are more complicated and the improved exposure helps get the best result.

Benefits of the Open Approach

The open approach allows for the nasal skin to be lifted up for full visibility of the nasal framework. This can result in more precise, and in some cases, better results with improved symmetry. This technique gives your surgeon more control over the procedure and can more easily stabilize the nose.

Difficulties of the Open Approach

The only downside of the open approach is the external incision along the columella. Dr. Pontell closes this incision meticulously, and it typically is not visible after the first month after surgery.

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