Open vs Closed Rhinoplasty

Rhinoplasty is plastic surgery performed on the nose. Open rhinoplasty is done through incisions created on the inside of the nose as well as a small incision across the columella (the strip of skin running from the tip of the nose to the upper lip that separates the nostrils). Closed rhinoplasty is done through small incisions on the inside of the nose so there are no external incisions that are visible. With open rhinoplasty, the doctor has an open view of all of the tissues underneath the skin. During closed rhinoplasty, the incisions are made on the inside of the nose so the tissues cannot be seen as much by the surgeon.

The advantage of closed rhinoplasty is that it can provide for a shorter surgery time and, potentially, a shorter recovery time without any visible incisions. The advantage of open rhinoplasty is that the surgeon has access to all the soft tissues underneath the skin. The disadvantage of open rhinoplasty is that there is more dissection and more surgery involved so it can potentially lead to a longer surgery time as well as a longer recovery time. The disadvantage of closed rhinoplasty is that others may not be able to see as big a difference in results as they would with open rhinoplasty.

Am I a Good Candidate for Open and Closed Rhinoplasty?

GOOD CANDIDATES for open and closed rhinoplasty include:

• An ideal patient for closed rhinoplasty is someone who wants to make changes to the nasal dorsum, the nasal side walls and some minor changes to the nasal tip
• An ideal closed rhinoplasty patient hasn’t had a lot of nasal trauma or previous surgery
• An ideal candidate for open rhinoplasty is a person with a complex anatomy and the reconstruction is carried out using multiple tissue and cartilage grafts to the tip of the nose
• Open rhinoplasty benefits someone with significant deformities of the nasal soft tissues and cartilage
• Both techniques are ideal for a person who is self-conscious about the appearance of their nose
• Open and closed rhinoplasty candidates are people with a bridge or bulbous tip on their nose or someone with breathing issues because of the structure of the nose

Patients who are NOT GOOD CANDIDATES for open or closed rhinoplasty include:

• A person in their teens with a nose that is not fully grown or developed yet
• Someone who expects the new look of their nose to completely transform the appearance of their face
• A person having the surgery to make someone else happy with their appearance

How is Open and Closed Rhinoplasty Performed?

The decision of which type of rhinoplasty to have is determined after the patient is examined by the doctor.

Many patients prefer closed rhinoplasty because all of the surgical incisions are made inside the nose. Closed rhinoplasty is often used to address the bridge of the nose. This technique eliminates the possibility of any external scarring. Although the incisions are hidden, the surgeon can still access most of the nose to address a range of cosmetic and structural concerns.

Open rhinoplasty allows the surgeon access to a larger part of the cartilage and bone of the nose. However, this method will leave some scar tissue on the nose. The doctor creates an incision across the columella and then lifts the skin off the tip of the nose. This gives the surgeon the chance to shape the cartilage in a precise manner. The scar that is left behind is a small scar on the underside of the nose.

No matter which technique is used, there are certain steps that are common to both methods.

1. The surgeon uses general anesthesia or IV sedation to put the patient to sleep during the surgery.
2. The surgeon creates tiny incisions on the columella or inside the nose.
3. The skin is lifted to access the underlying cartilage and bone. The doctor then removes or grafts tissues (depending on the needs of the patient).
4. Once the necessary changes are made, the skin is placed back over the new contours of the nose and the incisions are closed.
5. A splint or pieces of gauze/nasal packing are placed to help retain the new shape of the nose.

Types of Rhinoplasty

Reduction Rhinoplasty – A procedure that gives a patient a nose that is more proportionate in appearance to the other facial features by removing bumps on the bridge of the nose or addressing a long nasal tip. The doctor removes bone and cartilage to reduce the size of the nostrils.

Augmentation Rhinoplasty – The doctor builds up the nasal bridge or tip by performing bone or tissue grafting. Cartilage from other parts of the nose can be used as well as cartilage from other areas of the body or synthetic materials.

Revision Rhinoplasty – A rhinoplasty procedure that augments or corrects the results from a previous rhinoplasty surgery.

Adolescent Rhinoplasty – Teenage patients usually need to wait until their noses have stopped growing before they have rhinoplasty. In cases of trauma or breathing difficulties, young patients can have rhinoplasty but the doctor must take care to protect the nasal features that are still developing.

Ethnic Rhinoplasty – This refers to rhinoplasty performed on individuals of African American, Asian and Middle Eastern descent. These ethnicities normally have a softer nasal contour so a doctor must work to preserve their unique facial features.

Reconstructive Rhinoplasty – Patients that have lost all, or some, of their nose due to skin cancer, an illness or an accident require reconstructive rhinoplasty. The surgeon rebuilds the nose through the use of skin grafts or flap techniques. Depending on the nature of the issue, multiple surgeries may be required to achieve the desired results.

Combined with Other Procedures

Open and closed rhinoplasty is often combined with other procedures since the nose has such a prominent position on the face. They include chin augmentation and reduction, a facelift, blepharoplasty (eyelid surgery), cheek augmentation and a brow lift. When combined with either rhinoplasty technique, these procedures help provide balance and overall proportion to the face.

What are the Costs of Open and Closed Rhinoplasty?

The total cost depends on the technique used by the surgeon, the geographic location of the surgery, any fees charged by the doctor or the facility and whether or not any of the surgery is covered by insurance. If rhinoplasty is being performed for reconstructive or breathing issues, insurance will likely cover a portion of the cost. Open rhinoplasty might cost more than closed rhinoplasty because the doctor has access to a greater amount of the nose during the surgery. It all depends on the amount of work that needs to be performed by the surgeon. In general, the cost of open and closed rhinoplasty is anywhere from $6000-$15,000.

Recovery and Downtime

The RECOVERY time for a patient depends on how much work was done on the nose with either technique. During the first few weeks after surgery, patients should sleep with their head elevated and apply a cold compress to the nose to help with any swelling. They should also avoid blowing their nose and clean their gauze or bandages as directed.  There will be some bruising and swelling around the eyes and nose for 2 to 3 weeks.

After about two weeks of DOWNTIME, patients can return to work. They should avoid strenuous activities and exercise as instructed by the doctor. They should also wear sunscreen when they go outside and not wear glasses for 2-4 weeks.

Results

The results will initially be obscured by bruising and swelling on the face. In the months after the surgery, the nose will start to contour and settle into its final shape. It can take up to a year for the final results of open or closed rhinoplasty to become visible to others. Because the final results of rhinoplasty can take up to a year to appear, doctors discourage patients from undergoing revision rhinoplasty until after the final results are visible. In closed rhinoplasty, all incisions are made inside the nostrils so there will not be any visible scars. In open rhinoplasty, an incision is made across the columella that may leave a small scar. Thanks to the size and location of the incision, this small scar is usually unnoticeable.

Limitations of Open and Closed Rhinoplasty

Some common limitations of open and closed rhinoplasty include:

• The degree to which the tip or length of the nose can be altered
• The amount of balance or proportion the nose can have relative to the rest of the face
• The amount of tissue or cartilage that can be removed and still have natural looking results
• The amount of reduction that can be achieved on a large nose

Risks of Open and Closed Rhinoplasty

The risks of open and closed rhinoplasty include:

• Bruising
• Swelling
• Scarring
• Infection
• Asymmetry
• Numbness
• Hematoma – Blood collecting under the skin
• Breathing difficulties
• Burst blood vessels 

Consult with a Board-Certified Doctor

Depending upon the patient’s natural anatomy and the desired results, the surgeon will decide between open and closed rhinoplasty after a consultation appointment. While there are benefits to both techniques, patients should do their research and ask a board-certified doctor for “before and after” photos of both techniques performed on actual, patients. Rhinoplasty can provide improvements in both the appearance and function of the nose as well as the self-confidence and self-image of a patient.

Cosmetic Town is the premier online cosmetic surgery news and information resource. We connect patients with the best doctors for cosmetic procedures. Get the answers to all of your questions and find a doctor near you.

Written by Cosmetic Town Editorial Team- MA

Exclusive interview provided by Dr. John Rachel of MetropolitanMD in Chicago, IL.