Rhinoplasty: Open vs. Closed
There is a great deal of back and forth as to which technique achieves the better result; most of which has to do with how the surgeon was trained as well as his or her comfort level. Both types of rhinoplasty can achieve excellent results given your surgeon has a firm understanding of nasal anatomy, structural integrity, as well as physiology.
Closed Rhinoplasty or closed technique involves incisions made entirely inside the nostril without any outside incisions or potential scars. This takes much more technical skill as well as manual dexterity and should be reserved for the experienced surgeon.
Open Rhinoplasty or open technique involves incisions made along the inside of the nostril as well as through the outside of the columella. The columella is the tissue which separates the right and left nostrils and extends from the tip of the nose to the upper lip. The incision through the columella is the distinguishing factor between open and closed rhinoplasty. There also tends to be more post-operative swelling after an open rhinoplasty, secondary to disrupting the blood vessels within the columella when making an incision in this area. For the inexperienced surgeon or occasional rhinoplasty surgeon the open technique is advantageous.
The decision as to which technique is used lies solely with your surgeon and his comfort level. The Master Cosmetic will be adept at both procedures and choose which technique will afford the best possible outcome. I have noted that most of the newer or younger plastic surgeons tend to perform the open technique for most, if not all of their rhinoplasty patients. Most of this has to do with the Surgeons prior training and comfort level. Most plastic and cosmetic surgeons observe or participate in the open technique in their residence programs for the simple fact of being able to see what is being done during surgery. It is very difficult as well as time consuming for the surgeon to step out so that one or two residents can look inside the nose and grasp a firm understanding of what is being done and why during a closed rhinoplasty. On the other hand most veterans of E.N.T. (ear, nose, and throat) surgery and facial plastic can perform closed rhinoplasty as well as open rhinoplasty without hesitation. These surgeons send a large portion of their residence training “inside the nose”. From sinus surgery to nasal reconstruction these residents have had a masterful understanding of all aspects of the nose.
Having assisted and performed over a thousand rhinoplasty procedures and nasal surgeries during Residency and Fellowship I tend to use the closed technique for the majority of cosmetic rhinoplasty patients and reserve the open technique for those patients with structural compromise or those seeking reconstruction after severe facial trauma.
The Meat and Potatoes
Both the open and closed technique can yield excellent results for cosmetic nasal surgery. The skill of your surgeon will determine the outcome and not whether the technique is open or closed. You should choose a Cosmetic Surgeon whose judgment and skill you trust. Lastly, do not rely on photo imaging. Photo imaging is only a tool. It does not take into consideration underlying nasal structures, skin thickness, and cannot anticipate how you are going to heal. It is more important to see before and after photos of the Surgeons rhinoplasty patients who have a similar nose to you.
-Dr. Robert Marouk
As always we invite you to come in for a complimentary consultation and speak with Dr. Marouk about which technique would be best for you. To schedule please give our office a call at 480-814-1112.
Below is an actual patient of Dr. Marouks before and after closed rhinoplasty.