Open or Closed Rhinoplasty: A Comparison of Rhinoplasty Techniques

The difference between an open or closed rhinoplasty is the location and visibility of the incisions. In an open rhinoplasty, an incision is made across the bottom of the columnella, the bottom of the septum that separates the nostrils. Sometimes, additional incisions are made in the corner folds of the nostrils, if the size of the nostrils is being adjusted. These incisions are usually very minimal after healing, if they can be seen at all. A closed rhinoplasty involves incisions made inside the nostril in the mucous membrane of the nose, where they will be invisible.

Open rhinoplasty is sometimes referred to as an external approach. Closed rhinoplasty is sometimes called endonasal rhinoplasty. 

So why would anyone want to have even very minimally visible scars if they could choose not to have them? Sometimes you don't have a choice.  In closed rhinoplasty, the surgeon may not be able to completely see what he or she is doing. Generally, an open technique may be necessary in more extensive types of rhinoplasty, where a lot of reconstruction or correction is needed.  

Not all cosmetic surgeons do both open and closed rhinoplasties or may greatly prefer one over the other, so you need to consult with several surgeons. Some surgeons strongly believe that open technique is best and others believe that only the most extensive rhinoplasty needs to be done in an open fashion. However, listen to what they say. If two or more surgeons tell you that you ought to go with an open technique, maybe you do need it. Don't select your plastic surgeon based only on which rhinoplasty technique he or she will use. 

Understand also that a surgeon may start your surgery intending to do use a closed procedure, but then have to switch to an open procedure. The presence of scar tissue from previous surgery or trauma may make a closed procedure more difficult than expected. This change of plans happens rarely, but it can occur.

Closed Rhinoplasty Surgery

In a closed rhinoplasty, the surgeon makes incisions inside of the nostrils. The skin on the nose is still moved around a great deal. Usually, incisions will be made in both nostrils. The locations of the incisions will depend on what parts of the nasal bones and cartilage have to be adjusted. 

At the end of the surgery, the incisions within the nostrils will be closed with sutures.

Open Rhinoplasty Surgery

In an open rhinoplasty, the surgeon makes a short incision across the columella, the vertical bit of skin and cartilage that separates the nostrils. This incision will be V-shaped, or sometimes W-shaped and be just in front of where the skin of the columella joins to the skin of the upper lip. 

Open rhinoplasty incisions are almost invisible and even if they are not, they are located under your nose, where they are usually out of sight. Unless the scar heals poorly, it can rarely be seen unless someone was looking up your nose, and how often does that happen outside of a medical office? 

The skin and thin fat layer of your nose is then pulled back and secured with a device called a retractor. This actually looks a bit gruesome and like the skin will never go back into its normal position, but it does. The skin is very resilient in most people and can bounce back to its original state with only a bit of bruising that goes away. The surgeon then continues with the procedure and reshapes the bone and cartilage of the nose.If you have very wide nostrils and your rhinoplasty involves adjusting their shape, you will also have small incisions in the crease around the outside of the nostril. After the surgery, the incision across the columella is closed with sutures.