Open vs. Closed Rhinoplasty: Which One Is for You?
- 15 August 2016
- Dr. Mark Broudo
Rhinoplasty—commonly known as a nose job—is a wildly popular procedure, but if there is one dilemma that almost every patient encounters, it is choosing between the open and closed rhinoplasty.
These techniques are both extremely effective for the patient, but they differ in terms of indication and process.
It is important that you know the difference between the two so that you can provide some input to your cosmetic surgeon when you are already deciding on which technique will suit you best.
Here are some basic things that you need to remember about open and closed rhinoplasty.
Also known as external rhinoplasty, open rhinoplasty involves making a small, zigzag type incision in the nose’s columella—the lower part of the nasal septum that separates the nostrils—and then making additional incisions inside the nose. This way, your surgeon can lift the skin off the tip of the nose, pretty much like opening the hood of a car.
The extent of the incisions gives your surgeon greater access to nearly the entire nasal framework where the individual components of the nose—such as the cartilage and bone—can be evaluated in their natural and undisturbed position. Your surgeon can shape your nose in the most precise way possible, providing it with much-needed symmetry as the entire nose can be visualized at once. Sutures are used to close the incisions. Once healed, the external incision leaves a very small and inconspicuous scar on the underside of your nose.
Open rhinoplasty is best for patients suffering from various nasal deformities such as cleft lip and palate, deviated septum, internal nasal valve dysfunction, and septal perforations. It is also the technique of choice for those requiring a nasal tumor excision or nasal tip modification. The open rhinoplasty can also be done on patients undergoing secondary rhinoplasty, as this often necessitates a complex procedure. Non-Caucasian ethnic groups also often prefer this technique.
But given the fact that this technique is more invasive than the closed variety, it also follows that it has more risks than the latter. For one, the whole process is longer than closed rhinoplasty. Scarring is also a possibility, although the zigzag approach to the incision makes it easier to camouflage it. The process of lifting the nasal skin up can also lead to more skin swelling compared with the closed rhinoplasty. You might also experience temporary skin numbness that gradually resolves after eight to nine months.
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Closed rhinoplasty—also known as endonasal rhinoplasty—is named as such because all the incisions are positioned inside the nostrils. Because no part of the incisions is visible outside, it does not have any visible scarring—making it the technique of choice for patients wanting to take advantage of the cosmetic benefits of rhinoplasty.
The first incision is usually made along the undersurface of both nostrils. It is called a marginal incision, which is made in an arc-like fashion corresponding to the border
of the lower lateral cartilage. The second incision, known as the intercartilaginous incision, is placed between the lower lateral cartilage and the upper lateral cartilage. It extends along the sides of the septum, allowing your surgeon to still gain access to most of the nose.
However, since the incisions in the right and left nostrils remain disconnected, repositioning of the nasal skin can be difficult. Your surgeon has reduced visibility compared to an open rhinoplasty as he performs the entire operation through narrow surgical openings.
The biggest advantage of getting a closed rhinoplasty is that you do not have to worry about visible scars. It also has a shorter operation time compared to an open rhinoplasty and a reduction of swelling after surgery because the natural drainage channels of the overlying skin have not been disrupted. The risks are even more minimal than the open approach. In general, it is easier and faster to get back your normal appearance after a closed rhinoplasty.
However, this approach poses considerable challenges and technical limitations because of the lack of surgical access. This is especially true for the more complex rhinoplasty maneuvers, like modifying the tip shape and position of the nose. As such, it is best used for patients suffering from aesthetic nasal deformities and wanting only to get a bridge augmentation or a minor bridge refinement.
Choosing the right technique
With both techniques having high success rates, it can be difficult to choose which one is best for you. Usually, the verdict will be based on the natural shape of your nose, as well as your overall rhinoplasty goals.
For instance, if you want to make dramatic changes in your nose, an open rhinoplasty might be the way to go. This applies not only to people who have lofty aesthetic goals, but also those who suffered from traumatic injuries that necessitate a rhinoplasty. In this technique, your surgeon is given access to a larger part of your nose, making it easy for him to create drastic changes in your nose, including adjustments to your nasal tip. On the other hand, if you just want to address the bridge of your nose, then a closed rhinoplasty is already enough.
You may even choose some advanced rhinoplasty techniques, if available in your chosen Miami clinic. Nowadays, there are high-power tools that create tiny alterations to your nasal bone allowing your surgeon to correct a nasal injury or deviated septum without re-fracturing the nose and disturbing the surrounding tissue. There is even an advanced technique that makes use of your own blood as a natural adhesive, allowing your doctor to seal incisions from the inside, hence minimizing scarring and post-surgical bruising.
Keep in mind that there is no hard and fast rule regarding the right technique to use, as it all depends not only on your desires but also on your rhinoplasty needs. To learn more about the open and closed rhinoplasty techniques, Schedule a Free Consultation with one of our top-rated surgeons here on Face + Body Cosmetic Surgery.