Chapter 20

Chapter 20: Open vs. Closed Rhinoplasty

Rhinoplasty can be performed through two principal surgical approaches: the open approach and the closed approach. Both methods have unique advantages and potential drawbacks, and the choice of technique depends on the patient’s anatomy, goals, and the surgeon’s expertise. Understanding these approaches helps patients feel informed and confident as they prepare for surgery.

The Open Approach

In open rhinoplasty, a small incision is made across the columella, the narrow strip of skin that separates the nostrils. The nasal skin is then lifted upward, exposing the underlying cartilage and bone. This provides the surgeon with direct visualization of the nasal structures, allowing for precise modifications and detailed reconstruction.

Open rhinoplasty is particularly advantageous in complex cases, such as revision surgeries, asymmetric deformities, or when extensive grafting is required. The increased visibility gives the surgeon greater control and accuracy. While patients may be concerned about scarring, the incision typically heals very well and is barely visible over time.

Some patients may experience more swelling initially with the open technique compared to closed rhinoplasty, but this difference diminishes over the course of healing. In exchange, patients benefit from the enhanced precision that this approach affords.

The Closed Approach

In closed rhinoplasty, all incisions are placed inside the nostrils, leaving no external scar. Through these hidden incisions, the surgeon works within the nasal framework to perform necessary modifications. Because the nasal skin is not lifted, there is less dissection, and some surgeons find that swelling may resolve faster.

Closed rhinoplasty is often preferred for more straightforward cases, such as minor dorsal hump reduction or modest tip refinements. It is also the approach of choice for patients who strongly prefer to avoid any external incision. However, limited visibility can make intricate tip work and complex grafting more challenging.

Choosing the Right Approach

The decision between open and closed rhinoplasty should not be viewed as a matter of one being superior to the other. Rather, the choice depends on the specifics of each case. Surgeons may favor one approach or may use both depending on the patient’s needs. What matters most is the skill, artistry, and judgment of the surgeon, not the incision itself.

For some patients, the open approach provides the best chance for a predictable, natural-looking result. For others, a closed approach offers all the refinements needed without the additional incision. Ultimately, the approach is a technical detail that supports the larger goal: a balanced, functional, and harmonious nose.

Recovery and Results

Both open and closed rhinoplasty require a similar recovery timeline. Most patients can return to normal activities within one to two weeks, though swelling can take months to fully resolve. With open rhinoplasty, swelling at the tip of the nose may take slightly longer to subside, but the long-term outcomes of both approaches are equally rewarding when performed with expertise.

Patients should feel reassured that the approach chosen by their surgeon is guided by safety, function, and aesthetics. What matters is not the path taken, but the artistry and precision applied along the way.