Rhinoplasty: Is that Open or Closed?
Surgical markings are where an open rhinoplasty begins
You may know me here mostly for gynecomastia surgery but I also do many other plastic surgery procedures.
One of my favorite and most frequently performed plastic surgery procedures is the “nose job” or rhinoplasty. Because a human nose is so small and intricate, with many interconnecting tissues, it is something like working on a living watch.
One of the first questions patients ask is about open and closed rhinoplasties. (Most of what we do is the closed). I always explain that it is like a car repair: lift the hood and repair the engine (open rhinoplasty) versus remove the front grill and repair the engine through a smaller opening (closed rhinoplasty).
When a cosmetic plastic surgeon starts a rhinoplasty procedure, there are two approaches. Those are:
- The open, or external, approach
Feel the tiny strip of skin that keeps your nostrils apart and note how small the area is. One finger tip can cover the place where surgeons start. An incision is made there and then the skin is lifted up and back to reveal the architecture of the nose.
- The closed technique
In this choice, the surgeon operates through the nostrils, without pulling back the skin of the nose. Some surgeons favor this approach although it requires extra training and is more demanding due to the small tolerances in the nose.
Also known as the endonasal approach, it offers some advantages, including allowing the surgeon to immediately visualize what the final result is going to look like.
When using the open technique, however, the nose skin must first be pulled back into place over the framework of the nose to get a concept what the nose’s outcome will be.
Another upside to the closed procedure: it heals faster. If the skin over the nose is lifted, the lymphatic drainage system is interrupted. That also causes more swelling.
Or, if the surgeon is not getting the results desired during a close procedure, he or she may go ahead and open the nose up for better visibility. This is often done if there are severe distortions or asymmetries of the tip structures or if it is revision, or secondary, operation.
The thing is, if the surgeon starts with an open approach, he can’t go back to a closed and enjoy its particular benefits.
Which is best?
If you like the quicker healing of the closed approach, do the next logical thing and look at the surgeon’s before and after rhinoplasty pictures to make sure all the noses you see look natural, fitting and flatter the owners’ faces.
(Read more about a rhinoplasty from Dr. Jacobs.)