Perhaps one of the most confusing dilemmas confronting the prospective rhinoplasty patient is the choice of whether to have an open versus closed rhinoplasty. For some people this seems to be the case as some surgeons perform either one or the other approach exclusively so when you select your rhinoplasty surgeon you are also deciding on the surgical approach that will be used. To further complicate matters, when researching rhinoplasty incision placement and surgical approaches you will run into a lot of conflicting opinion (from patients and surgeons alike!) about which method is “best” to use. In actuality, the open versus closed terms simply refer to the two possible ways of the accessing the skeletal framework to perform rhinoplasty surgery. Dr. Saran’s Clinic uses both techniques and selects the best approach to use based on the goals of surgery and what nasal modifications need to be made.
Closed Rhinoplasty (Endonasal Rhinoplasty)
In the closed rhinoplasty approach, also called endonasal rhinoplasty, all of the surgical incisions are positioned inside the nostrils such that no part of the incision can be seen externally and a visible scar is avoided. However, since the right and left nostril incisions remain disconnected, repositioning of the nasal skin is difficult and the entire operation is performed through narrow surgical openings with reduced visibility. While a visible scar is prevented there are considerable challenges and technical limitations associated with the relative lack of surgical access, especially when it comes to more complex rhinoplasty maneuvers such as modifying tip shape and position. This is especially the case when a structure-based rhinoplasty philosophy is followed in which nasal support is maintained or improved during surgery using structural grafting techniques.
Open Rhinoplasty (External Rhinoplasty)
The open or external rhinoplasty approach also uses a few hidden internal incisions and adds a small incision that is placed across the columella to connect the right and left nostril incisions.
With the addition of this 5 mm or so visible incision, the nasal skin can be folded upward much like opening the hood of a car.  This results in direct visibility and excellent access to nearly the entire nasal framework where the individual components of the nose can be evaluated in their natural, undisturbed position. This also affords surgeons the ability to create as much symmetry as possible since the entire nose is able to be visualized at once (rather than through separate incisions on each side of the nose).
Downsides to using the open rhinoplasty approach
The process of lifting the nasal skin up during open rhinoplasty does tend to lead to more skin swelling compared with using a closed approach. It is also normal to have temporary skin tip numbness that gradually resolves after 8 or 9 months.