Rhinoplasty: Closed or Open Procedure?

Is it better to have closed rhinoplasty surgery or the open procedure?

First, even though the term “procedure” is commonly used when discussing rhinoplasty, it really is not accurate. In most dictionaries, a procedure is defined as “a series of actions conducted in a certain order or manner”. That is not a good way to look at rhinoplasty, whether closed or open. There may be types of surgeries that fall under simple or routine, but rhinoplasty is not one of them. In fact, it is considered one of the most challenging operations there is and, perhaps, the most difficult of all types of plastic surgery.The nose is not only the most prominent feature on the face, it is also has  three-dimensional shape, making it very complicated. Changes, even extremely small ones, can have a significant effect in how the nose looks and how well it functions. Each person’s nose is also unique, with differences being as plentiful as similarities. This makes no two nose surgeries alike. Each one must be designed, specifically, for that individual patient, which means that rhinoplasty surgeons never follow a “series of actions conducted in a certain order or manner”.

Closed Rhinoplasty or Open Rhinoplasty

Historically, most nose surgery was done via the closed method. Also known as endonasal, incisions are made through the nostrils rather than making exterior incisions, usually on the columella, as is done with open rhinoplasty. Use of exterior incisions became more common when the cookie cutter nose became unpopular. Surgeons felt that having a better view of the interior of the nose gave them more of an ability to make changes that would fit the goals and preferences of the patient. Because it is so much easier to observe what is going on during an open procedure, it is often used to train new surgeons.Both methods have their advocates. That said, working entirely within the nose requires a great deal of manual dexterity, skill and many years of experience before a surgeon becomes truly proficient and confident. Those who practice this method do so because they believe that there are many benefits for the patient.

Some of the advantages that experienced surgeons believe are available with closed rhinoplasty surgery include:

• No visible scarring because there are no external incisions
• Very little pain
• No internal packing, which can be extremely uncomfortable
• Less post-operative bruising and swelling
• Shorter recovery period
• Less time required for the surgery
• Quicker return to a normal appearance

Is one method always better than the other? As in so many areas, it all depends on who you ask. In the end, the choice between methods, no matter what type of surgery you are contemplating, comes down to your trust and confidence in your surgeon. It will always be important for you to be as informed as possible about all the pros and cons, but, ultimately, your choice of surgeon will be the deciding factor. That’s why the number one most important step will always be to find the most highly-skilled and experienced rhinoplasty surgeon that you can.You could not make a better decision than consulting with Dr. Geoffrey Tobias, New York City’s only plastic surgeon exclusively practicing rhinoplasty. His experience, compassion and dedication have combined to have him recognized 12 times as “best in his field” by New York Magazine. To request a consultation, simply click here.