Although everyone’s nose is slightly different and what surgeon might change about the nose during rhinoplasty will differ from patient to patient, rhinoplasty can be divided into two main categories. There are open rhinoplasties and there are closed rhinoplasties. The differences between the two techniques refers to the method the surgeon uses for accessing the interior of the nose.
During a closed rhinoplasty, also called an endonasal rhinoplasty, the surgeon makes all of the incisions on the inside of the nose. In contrast, during an open rhinoplasty, or an external rhinoplasty, the surgeon makes one incision on the outside of the nose, and lifts the top of the nose back, providing a clear view of the interior.
It’s common for patients to think "I want a closed rhinoplasty" or "I want an open one." But, the decision is often the surgeon’s make, the different techniques allow him to access or work on different areas of the nose.
Benefits of Closed Rhinoplasty
From a patient’s point of view, the biggest benefit of a closed rhinoplasty is that there are no visible scars on the exterior of the nose. A person can enjoy the benefits of a nose job without the scar serving as evidence of the surgery.
Another benefit of a closed rhinoplasty procedure is that it typically has a shorter recovery time. Since fewer incisions are made during the procedure, there is less that needs to heal, as well as less swelling after surgery. Patients still need to take a week or two off from work and to take it easy for the first month or so after surgery, but they are more likely to feel better and to see improvement more quickly, compared to those who have an open procedure.
Benefits of Open Rhinoplasty
If a closed rhinoplasty means less recovery time and no visible scarring, you might wonder why anyone would want an open rhinoplasty. As it turns out, an open procedure allows the surgeon greater access to the interior of the nose. During an open rhinoplasty, a surgeon can do things to the nose he just can’t do during a closed surgery.
For example, during a closed rhinoplasty, the nasal cavities remain divided. It’s more difficult for a surgeon to fully reshape the cartilage during a closed procedure and it can be challenging for a surgeon to re-drape the nasal skin during the surgery. During a closed rhinoplasty, there’s an increased risk for deformity of the nasal cartilage and for excess stretching of the skin in the nasal area.
In contrast, during an open surgery, the surgeon has easy access to the interior of the nose. The top of the nose is flipped up, similar to the way you might open the hood of a car. The surgeon can clearly see and manipulate the nasal skeleton. It’s also easier for a surgeon to work on the tip of the nose during an open procedure.
While the open technique does involve making a scar across the columella, the tissue that divides the nostrils, the size of the incision and the location of it means that it is likely not to be very visible once all is said and done. In many cases, the incision heals nicely, leaving almost no visible scar. Since the incision is placed on the underside of the nose, a person would have to lean down and stare directly up at another person’s nostrils to even catch a glimpse of it.
How Do You Choose?
In the end, deciding between open and closed rhinoplasty isn’t as simple as answering the question of "external scar or no external scar?" Your surgeon will evaluate what changes you’d like made to your nose, your expectations for the surgery, and a variety of other factors when deciding whether an open or closed procedure is best for you.
In fact, it can be a red flag if your surgeon insists that he only performs one type of rhinoplasty and not the other. While an open procedure might make sense for the majority of cases, it’s not always the best option. The same is true of a closed technique. You want to work with a surgeon who has the experience with and understanding of rhinoplasty to be able to choose the technique that best suits you and your nose.
Dr. Michael Schwartz is a facial plastic surgeon based in West Palm Beach, Florida, who specializes in rhinoplasty and ENT procedures. He has more than 24 years of experience as a facial plastic surgeon. To learn more about rhinoplasty and the various techniques, call 561-228-5888 to schedule a consultation with Dr. Schwartz today.