Open Versus Closed Rhinoplasty
For the public, researching rhinoplasty, or cosmetic nose surgery (the nose job), can be arduous and confusing. All sorts of terms appear, including strange phrases like "saddle-nose deformity" or "poly-beak nose." In this entry, I will address two specific terms that people often misunderstand: the "open" versus the "closed" rhinoplasty.
Each technique has its advantages and disadvantages. The best rhinoplasty surgeons are well-versed in both techniques, though they may choose to perform one more commonly than the other for various reasons. The closed rhinoplasty is a surgical procedure in which the only incisions made are inside the nasal passages. Open rhinoplasties, which provide the surgeon with improved exposure and the ability to see all of the structures of the nose, also include a small incision in the columella (see figure below), which is the slim wall separating the nostrils.
On the surface, the closed technique seems to be the obvious choice: no incisions except those hidden inside the nose! But the reality is more complex. Why?
Well, the great disadvantage of the closed technique is that the surgery permits only limited access to the structural components that form the framework (and therefore the shape) of the nose. In addition, any unusual anatomy, or changes caused by previous injury or previous surgery, cannot always be seen. Since every nose is unique, unexpected results can occur. The most likely place for problems to occur is the tip of the nose, which has a complex alignment of multiple cartilages that help form the shape of the nose.
Given the wide variety of noses I see in my practice, I prefer the open technique of rhinoplasty for most patients. I do perform surgeries using the closed technique at times, however. This allows me to perform a unique rhinoplasty depending on the patient and her or his cosmetic goals each time. With the closed technique, I find that I am often more limited in the changes I am willing to make, given that portions of the surgery are done by feel and/or without the ability to see how a change to one part of the nose affects the overall structure.
Different rhinoplasty surgeons will provide different answers to the unending debate between "open" and "closed" rhinoplasty techniques. The most important thing for you to do if you are interested in rhinoplasty is to meet with the surgeon of your choice and be certain that you are comfortable with the physician and that you can communicate to one another effectively and completely.
Best of luck!