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Open vs Closed Rhinoplasty Fully Explained

There are two surgical pathways into the framework of the nose to alter the bone and cartilage architecture: “Open Rhinoplasty” and “Closed Rhinoplasty”. Learn the differences of these two types of rhinoplasty methods and how results vary depending on if the surgeon chooses open vs closed rhinoplasty.

Open vs Closed Rhinoplasty

Closed rhinoplasty is an advanced surgical technique surgeons trained within the past 20 years are typically less skilled at. Open rhinoplasty can be advantageous with increased popularity of nose cartilage, bone and other tissue-grafting techniques. Open rhinoplasty may also be helpful in revision rhinoplasty. Closed rhinoplasties, due to their advanced technique are more advantageous when it comes to a majority of straight forward rhinoplasties.

When comparing open vs closed rhinoplasty remember these are merely surgical details. The most important factor in the success of the operation is the surgeon’s skill and talent. Great results can be achieved via either technique. Yes, there may be a somewhat shorter recovery period with the closed rhinoplasty and, yes, that external open rhinoplasty incision may take some weeks or even months to ripen and become nearly invisible, but those are relatively short-term issues. The end result is what counts. At three to four months when healing of a primary (first time) rhinoplasty is 80-90% complete, the differences between closed and open rhinoplasty become irrelevant.

Some surgeons are capable of performing the rhinoplasty via both open rhinoplasty and closed rhinoplasty techniques. Each procedure offers some advantages and disadvantages. Here are the common ones patients should know about

OPEN RHINOPLASTY ADVANTAGES

 
  • More comprehensive visualization of the outer structure of the nose, including both cartilage and bone.
  • Better for teaching other doctors and particularly surgeons-in-training, i.e. residents and fellows. 
  • Ease of stitching to reunite the various parts.

OPEN RHINOPLASTY DISADVANTAGES

 
  • Potential visibility of the external incision/scar
  • Potential minimal longer healing time/swelling due to the greater number of incisions and elevating more skin from the bone and cartilage skeleton

CLOSED RHINOPLASTY ADVANTAGES

 
  • Invisibility of all incisions. That is preferred by patients who have concerns about “scar showing”.
  • No stitches need removal; all dissolve spontaneously
  • Slightly shorter operating time since fewer incisions to close.

CLOSED RHINOPLASTY DISADVANTAGES

 
  • Much more difficult for surgeons-in-training to master. Requires high case load in training to be proficient. 
  • Technically more difficult. “Doing an entire operation through a keyhole”, including
  • Creating the incisions and stitching the incisions closed.
  • Doing the operation from the inside out. Certain portions of the procedure can involve drawing some of the cartilage to the outside of the nose, correcting imperfections and then returning to the tissue’s bad. A certain “wow” factor, certainly.

Closed Rhinoplasty (Endonasal, Invisible Incision)

closed rhinoplasty example

Patients seeking a “hidden” rhinoplasty solution often turn to closed rhinoplasty as the procedure is less invasive and results in no visible scarring.

WHAT IS CLOSED RHINOPLASTY?

Closed rhinoplasty, AKA endonasal (inside the nose) rhinoplasty, is a rhinoplasty procedure that is performed inside the patient’s nose to make corrections to nasal asymmetry. It defines the operative technique whereby the entire operation, including functional components for breathing, as needed, is performed via internal hidden incisions. These incisions are closed with absorbable stitches.

HOW IS CLOSED RHINOPLASTY PERFORMED?

Closed rhinoplasty is performed entirely through incisions on the inside of the nose and those incisions are closed with absorbable stitches at the end of the operation. Done entirely through the nostrils.

Open Rhinoplasty (External Rhinoplasty)

Open rhinoplasty, which is often referred to as external rhinoplasty, allows for improved accuracy by the surgeon as it is performed by making a small incision on the patient’s columella.

WHAT IS OPEN RHINOPLASTY?

The open rhinoplasty approach is used to gain exposure to the structures under the skin which must be altered. It’s known as such because there is typically an external, visible (likely only temporary visibility) incision. The visible, outside incision is closed with several layers of stitches that are removed typically within a week. While the incision is visible at that time, with maturity over a period of months it usually becomes less conspicuous.

HOW IS OPEN RHINOPLASTY PERFORMED?

Horizontal, it passes through the columella or pillar separating the two nostrils and connects to internal incisions to raise the skin that covers the nose and reveals the bony and cartilage framework of the nose. The skin that has been raised is held elevated during the procedure and at the end is replaced to its bed and that horizontal incision closed with stitches that are removed at some time around a week after surgery.

Main Differences Between Open and Closed Rhinoplasty

Both open and closed rhinoplasty aim to improve functionality and often the appearance of the nose during the surgery. That being said, the procedures themselves are very different. Here is the main difference between the two:

  • PROCEDURE DIFFICULTY

    Closed rhinoplasty is much more difficult because the nose surgeon will operate from inside the patient’s nostrils, as opposed to using a small bridging incision as in open rhinoplasty.

 
  • OPERATING TIME

    Closed rhinoplasty has a shorter operation time. Not too much longer, but there is often a small increase in the time needed for open rhinoplasty because of the procedural process.

 
  • STITCHES

     
    For closed rhinoplasty the stitches that closed the incisions are absorbed over time and are on the inside of the nose. For open rhinoplasty, the visible, outside incision is closed with several layers of stitches. The internal layer stitches dissolve. But the outside stitches are removed, generally within a week. While the incision is visible at that time, with maturity over a period of months, it usually becomes less conspicuous.
 
  • INCISION VISIBILITY (SCARRING)

     
    For open rhinoplasty there’s an external, horizontal incision fashioned between the two nostrils. That incision is carried into the nasal interior where the extended incision becomes less visible. With time the incision usually fades from open rhinoplasty but, in some patients, it can remain visible. With closed rhinoplasty, the incision is completely invisible. That is preferred by patients who have concerns about “scar showing”.

Is Closed Rhinoplasty Cheaper than Open?

Price is not dependent on which technique is utilized. The differences in terms of time in the operating room are not so significant so as to have a major bearing on the surgeon’s fee for either the open or closed rhinoplasty.

Why would a doctor choose to give a patient an open rhinoplasty vs a closed?

Surgeons employ the open rhinoplasty approach if they have not been trained in the closed technique. Many surgeons, trained in the last 20 years, are not capable of performing the alternative closed technique because their teachers are not performing it. With the increased popularity of cartilage, bone and other tissue-grafting techniques, the open rhinoplasty offered some advantages. It may also be helpful in revision rhinoplasty. However, for most primary, straight-forward rhinoplasties, if the surgeon has the requisite technical skill and long experience – both absolutely essential – open rhinoplasty is less advantageous. 

Closed rhinoplasty is technically very challenging unless one was trained by master nasal surgeons who were excellent technicians. The burden is the need to perform an entire operation “through a key-hole”. “Cutting and sewing” through a small tunnel. It takes superior training, “good hands” and much experience. One has to be able to “ visualize” some portions of the nose without actually seeing them. However, the surgeon who is facile with this technique finds it “routine” and very favorable since the procedure has fewer incisions and therefore less chance of some problems. Surgeons who are comfortable and handy with the closed rhinoplasty can easily perform an open rhinoplasty. But surgeons who are open rhinoplasty advocates cannot easily make the transition to the closed technique.

Meet Dr. Kotler

Superspecialist and Board-certified facial cosmetic surgeon Dr. Robert Kotler has consistently delivered natural rhinoplasties for over 30 years. 

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