Open Rhinoplasty vs Closed Rhinoplasty

There is some debate among surgeons about whether open rhinoplasty is preferable to closed rhinoplasty. We aim to explain the difference between these two different rhinoplasty techniques.

The difference between Open and Closed Rhinoplasty starts with just one incision that is made during Open Rhinoplasty that will not be made during Closed Rhinoplasty.

In Open Rhinoplasty, an incision is made to the columella, between the nostrils, before making additional incisions inside the nose. With Closed Rhinoplasty, all of the incisions are made inside the nose.

The incision to the columella allows the surgeon peel back the nasal skin, providing a greater degree of access to the interior of the nose, and making more extensive reshaping possible.

When put like that, Open Rhinoplasty sounds rather traumatic, but, as with all cosmetic surgery procedures, the technique should be judged by the results, and Open Rhinoplasty does allow the surgeon to better plan and perform the operation.

Both Open Rhinoplasty and Closed Rhinoplasty have their supporters, who will argue that their preferred method is the better of the two. However, Open Rhinoplasty is now by far the more popular technique, and is the method now taught at medical schools.

It wasn’t always this way, and although it had been practiced fairly widely in Europe for many years, Open Rhinoplasty only really became widespread in US clinics and hospitals as recently as the 1990’s.


What are the Benefits of Open Rhinoplasty Compared to Closed Rhinoplasty?

Closed Rhinoplasty is great for instances where the degree of correction required is fairly minimal. If the patient wants a bump on the bridge of their nose corrected, and the bump is fairly slight, Closed Rhinoplasty may be appropriate. Similarly, Closed Rhinoplasty may be an option if the nose is not too crooked, and where the nose is generally in quite good proportion and shape.

Open Rhinoplasty is generally a better option when the degree of correction and reshaping required to the nose is more significant.

Open Rhinoplasty is also most surgeons’ choice if correction to the nose tip is required, such as when the tip of the nose is rather bulbous.

The great benefit of Open Rhinoplasty is that it allows the surgeon to examine the nasal anatomy. It allows the surgeon to look directly at up to one half of the internal nose structure. By exposing the cartilage that makes up the lower nose and the nose tip, the surgeon is better placed to reshape, modify and reduce the nose and tip.

Realistically, as most people opting for Rhinoplasty will have a greater rather than a lesser degree of correction required, the more common method used is Open Rhinoplasty. Most people will not be seeking nose reshaping unless they felt their nose could benefit from quite a lot of improvement, whether they feel that their nose is too big, or whether there has been a nasal fracture resulting from an accident.

How Much Scarring Can I Expect After Open Rhinoplasty?

It is not unusual for patients to worry about scarring as a result of Open Rhinoplasty.

As the Open Rhinoplasty procedure does involve an incision to the columella, a small scar will occur. However, the scarring that results from Open Rhinoplasty is extremely minimal, and very difficult to spot.

The incision is made as a tiny “v” shape or a zig-zig, which enables it to be camouflaged in a way that a straight incision would not. The “Open” procedure is now the most common, and very few patients experience any aesthetic problems as a result.

As the rest of the Open Rhinoplasty procedure is conducted inside the nasal cavity, in terms of scarring there is very little difference between the two techniques.

Our recommendation is to examine photos of your Rhinoplasty surgeon’s previous patients, after Open Rhinoplasty, to see if the results will be acceptable to you. As a patient, you should already be doing this, anyway.

Does Open Rhinoplasty Have a Longer Recovery Time Than Closed Rhinoplasty?

Open Rhinoplasty can be expected to have a longer recovery period than Closed Rhinoplasty.

This is not so much a result of the extra incision, and instead because of the more extensive reshaping that the open procedure allows, as well as the extra time that must be taken to open and close the nose.

Open Rhinoplasty has been described as taking the nose apart to put it back together again. Grafts are almost always introduced for added support, as the internal structure of the nose will have been modified and therefore weakened.

Open Rhinoplasty is definitely a more invasive procedure than Closed Rhinoplasty, which may be surprising, since in most areas of cosmetic surgery, the trend has been towards less invasive surgery, with minimally-invasive techniques developed that reduce recovery time. Uniquely, with Rhinoplasty, the move appears to have been in the opposite direction.

Still, the more-extensive modifications made the nose will naturally result in a longer recovery period, along with greater bruising and swelling to the area, due to the longer period of surgery.

What Are the Risks Involved in Open and Closed Rhinoplasty?

As always with any cosmetic surgery, there are risks, both to your health and well-being, but also the risk that the results of surgery are not what you hoped for.

In both instances, these risks can be minimized by making sure that your surgeon is competent, experienced and reputable. To make sure that the results will be how you hope, you should always ask to see before and after photos of previous patients.

In terms of risks specific to Open and Closed Rhinoplasty, it should be a reasonable assumption that the risk would be higher with Open Rhinoplasty, as it is more invasive.

However, since this is the technique that is now generally taught to medical students, and since the procedure makes it easier to see and understand the nasal anatomy, and therefore easier to plan and perform the surgery, many surgeons argue that Open Rhinoplasty is the safer option.

Is there a Difference in the Costs of Open and Closed Rhinoplasty?

You should not expect any significant cost difference between the two techniques, but rather for the differing extents of surgery required.

As it is likely that if you are getting Open Rhinoplasty your surgery will involve a greater degree of modification to your nose, this will require greater skill and take a longer period of time. It is reasonable to expect that the cost will be higher for a more challenging procedure.

So Should I Choose Open or Closed Rhinoplasty?

As so often, there is not a single, right answer to which procedure is best. While the majority of Rhinoplasty surgeons now favour the “Open” approach, there are still many surgeons who produce excellent results using the “Closed” technique. Many surgeons will also use both, depending on the situation.

Rhinoplasty is a procedure in which no two cases are the same, as everyone’s nasal anatomy is quite unique. Our advice is to find a reputable surgeon, with demonstrably good results, regardless of which type of rhinoplasty procedure he favours. He will have performed countless Rhinoplasties before, so you should probably trust his experience and intuition on what procedure will be correct for your cicumstances.

The best advice we can give you is not to get too hung-up on whether you will be getting Open Rhinoplasty or Closed Rhinoplasty, but rather, concentrate on finding a skilled and experienced surgeon who can give you the aesthetic results you want.