Open versus closed rhinoplasty

The difference between close and open rhinoplasty

Rhinoplasty is one of the most challenging operations in plastic surgery. For more than 3 decades, plastic surgeons have continued to present open versus closed rhinoplasty presentations and discussions, implying that one of the approaches is more advantageous over the other. From the first years of rhinoplasty it was a challenge figuring out how surgeons accessed the bone and cartilage beneath the skin (columella). The greatest fear in the past was cutting open the columella and not knowing where each anatomical bone structures exist. Luckily, through out the recent year surgeons have been able to evolve their way of conducting surgery to be able to preform successful ones. Closed-technique based rhinoplasty was the prelimery standard of doing surgeries but until the last three decades open-rinoplasty has gained popularity.


Open versus closed rhinoplasty


How are the two aforementioned techniques different?

In open-technique rhinoplasty, the columella is cut so therefore there is a scar in the columella. Alternatively, in the closed-technique there will be no scar in the columella as it remains untouched. It is obvious that there will be no difference on the alar parts as the alar bases can be cut in both methods.


The next question is to ask what are the pros and cons of these two techniques?

First of all the scar on the close-technique is untouched so therefore there is no complaints to scarring on the columella skin. In the open-technique rhinoplasty some patients complain about the cosmetic looks of the visible scar on the columella. In reference to the scar, the scar in the columella is existent as the columella skin had to be opened during open-technique surgery. However even though there is no scar transparent during the closed-base technique there are some issues to discuss. Some of these issues include that the tip is unmanipulated which does not give a favorable outcome. Since the closed-based technique does not have access to the columella therefore surgeons can not alter the tip position and perform refinement on the tip. In closed-based technique surgery there will be less edema and swelling as less tissue is dissected as compared to open-technique. Generally speaking these are common pros and cons that are related to the skill of the surgeon. A seasoned surgeon can be able to make better judgement if open or closed technique is appropriate for each patient. Most importantly the patient should make a wise decision with selecting a surgeon who has done many successful surgeries within various types of specialized nasal surgeries.