Rhinoplasty With the Open or Closed Techniques

When a plastic surgeon or a head and neck surgeon starts a rhinoplasty, he or she is going to start the procedure using one of two approaches:

• The open, or external, technique

The surgeon makes a small incision in the strip of skin that separates your two nostrils and pulls the skin back to reveal the architecture of the nose. Imagine opening the hood of a very tiny car.

• The closed technique

The surgeon operates through your nostrils. Some surgeons, including the ones at California Surgical Institute, favor this approach although it requires extra training and is more demanding due to the small tolerances in the nose.

Also known as the endonasal approach, the closed technique offers some advantages, including allowing the surgeon to immediately see what the final result is going to look like.

But if the surgeon is using the open technique, the nose skin must first be pulled back into place over the nose framework to get an idea of the nose’s final outcome.

The closed approach can heal faster. When the nasal skin is peeled back, the lymphatic drainage system is interrupted; that also causes more swelling.

Most surgeons who use the closed technique learn it from an older, more experienced plastic surgeon and that might require a year-long fellowship.

Of course, there are exceptions: if the surgeon is doing a repair of a previous nose job – a revision rhinoplasty — there may be too much scar tissue to allow the surgeon to get to the area where he needs to work. He may then switch to the open approach.

Or, if the surgeon is not getting the results wanted, he or she may go ahead and open the nose up for better visibility.

However, if the surgeon starts with an open, he or she can’t go back to a closed and enjoy its particular benefits.

A closed may be best for removing a nasal hump while changes in the tip of the nose may require an open.

Which is best?

If you like the quicker healing of the closed approach, do the next logical thing and look at the surgeon’s before and after rhinoplasty pictures and make sure all the noses you see look natural and fit well within the faces shown.