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What is the difference between an open and closed rhinoplasty?

Q:

What is the difference between an open rhinoplasty and a closed one?  Is correction of a deviated septum considered an open or closed rhinoplasty?

A:

In a closed rhinoplasty all surgery is done through the nostrils so there are no external scars. In an open rhinoplasty the surgeon makes an incision at the base of the columella, the strut of tissue between the nostrils, and elevates the skin off of the cartilages. He or she then alters the cartilage shape. Open versus closed rhinoplasty is a matter of personal training and preference on the part of the surgeon.

Personally, I was trained to do rhinoplasty closed, but I see no problem with either technique. The scar at the base of the columella in open rhinoplasty usually heals well.

John D. Newkirk, II M.D.
West Columbia, SC

A:

Open rhinoplasty is a technique where the columella is used as an access point to open the skin of the nose and see the underlying structures very directly.  Closed rhinoplasty is when rhinoplasty is performed through incisions made inside the nose.  This is also known as the endonasal approach.

Jay W. Calvert, M.D.
Beverly Hills, CA

A:

In doing a cosmetic rhinoplasty (nose job), a "closed technique" involves making incisions only inside the nose with no external visible incisions.  This is usually good for minor tip changes and bony changes.  Better visualization is obtained through an "open technique" where a small incision is made in the columella which is the vertical tissue between the right and left nostrils.  This allows better and often more precise visualization of the structures, and may contribute to a better clinical result.

A septal deviation can be corrected with a closed technique in most instances if simultaneous cosmetic changes aren't being done to the nasal tip.

A:

It is true that the open approach has a visible incision and the closed does not.  However, there are more important differences.  For the sake of disclosure, I only perform closed rhinoplasty, and this is why:

The open approach requires the surgeon to dissect further and disconnect more natural supporting structures, therefore obliging him or her to re-establish support with grafts or sutures, all variables that I would like to avoid.  Dissections are generally wider and therefore more risky in secondary patients, as outcome data has shown.  Finally, because the soft tissues are not in their resting position, it is harder for the surgeon to assess nuances in nasal shape.

Expert open rhinoplasty surgeons can get excellent results, but for most surgeons the open approach may have significant disadvantages.

A:

Distinguishing Between An Open or Closed Rhinoplasty – There is only a 6mm difference between an open and closed rhinoplasty. An open approach allows you to see the deformity and correct it using direct visualization. It is my preference to do open rhinoplasty on the majority of patients.

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