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.