Two Basic Rhinoplasty Procedures

Nose reshaping surgery can be divided into two types of procedures; open (external) rhinoplasty and closed (internal) rhinoplasty.

Briefly, the term open rhinoplasty describes the surgical technique by which an external incision is made in the area between the two nostrils.  In a closed rhinoplasty all incisions are made within the nasal structure.

It’s a matter of the surgeon’s preference and experience as to which technique he or she uses for a given case.

In an open rhinoplasty the horizontal incision allows for the skin to be lifted to more easily view and gain access to the nose tip cartilage.  The plus side of open (external) rhinoplasty is the increased access to certain nasal structures.  On the minus side is the small external incision and potential of light scarring. 

A closed rhinoplasty is done entirely within the nose with no external incisions.  This procedure takes more technical facility and manual dexterity than the open procedure. 

Both the open and closed procedures have been used by plastic surgeons for decades.

With an open rhinoplasty the surgeon can directly view the cartilage and other structure within the nose more easily than with a closed approach.  He or she can also more easily make changes with more control and precision.  Some changes can, in fact, only be completed using the open rhinoplasty procedure.

Open rhinoplasty is usually chosen for more complex procedures such as severely deviated nasal structure, and more complicated nasal deformities such as cleft-lip rhinoplasty.

Other more routine procedures in which cosmetic surgeons may choose open rhinoplasty are treating a bulbous tip, droopy, pinched or projected tip.

Closed rhinoplasty is usually chosen for smaller changes which can be done without the direct access and viewing provided by the incision on the outside of the nose. 

In a closed rhinoplasty, also called an endonasal rhinoplasty, all the incisions are made within the nose.  The entire operation is performed through narrow openings made within the nostrils.  The plastic surgeon confronts considerable challenges and some technical limitations caused by the lessened surgical access.  This is especially true of more complex rhinoplasty procedures.

Closed rhinoplasty has the advantages of less time in surgery, less swelling and quicker healing.  There is also no scar on the outside of the nose. The disadvantages are the lack of access to structure offered by the open rhinoplasty approach and the lessened direct visibility.

If your surgeon elects to use an open rhinoplasty procedure and you are concerned about the possibility of scarring, ask to see before and after pictures. 

The most important consideration when deciding whether to use an open or closed rhinoplasty is the comfort and experience of the surgeon.  As a patient you must choose a plastic surgeon you respect and in whom you have confidence.  The surgeon will then choose the most appropriate way of approaching your particular situation.  Follow their lead and you will most like be happy with the results of your rhinoplasty procedure.