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Should you have an open or closed rhinoplasty?

Open Or Closed Rhinoplasty?

Philip J. Miller, MD
60 East 56th South, 3rd Floor
New York, NY 10022
(212) 750-7100

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Dr. Miller

Should you have an open or closed rhinoplasty?

First of all, it is important for us to define what those 2 procedures are. A closed rhinoplasty, also called an endonasal rhinoplasty, is a surgical procedure wherein all of the incisions made for recontouring and reconstructing the nose are made inside the nostrils. After making the incisions, the skin is lifted off of the underlying cartilage and bone, but there are no skin incisions.

An open rhinoplasty is also called an external rhinoplasty because there is a very small incision placed on the columella (the piece of skin between your 2 nostrils) that allows one to "open" the tip of the nose and therefore reveal the structure of the lower and middle third of the nose much like one would in opening up the hood of a car. Which one is better?

There are proponents who strongly feel that there is no need to place the incision on the outside of the nose to perform a primary (i.e. a first time) rhinoplasty and that an external rhinoplasty should be reserved for significantly difficult revision cases.

However, there are those who are ardent fans of the external rhinoplasty approach who will perform this procedure on both a revision as well as primary cases.

Which one is right?
The answer really depends upon the experience and skill of the surgeon as well as the complexity and difficulty of the actual patient's nose. There are those who are extraordinarily skilled at external rhinoplasty and who favor that approach regardless of the deformity and who get excellent results and there are those who favor endonasal rhinoplasty or closed rhinoplasty and get excellent results with that approach.

So which one do you choose?
The answer that makes most sense is to be satisfied with the surgical results of your surgeon. It would not be prudent to proceed with either an external or an endonasal favoring surgeon if you are selecting them for the approach as apposed to the result. Emphasis should always be placed on the surgical result as apposed to concern of either an external scar or a preference for all incisions on the inside of the nose. With that being said, all things being equal, most patient's would obviously choose an individual who could perform a surgery placing incisions on the inside of their nose or an endonasal approach. Again, if it is a choice between an external incision or obtaining a surgical result that you do not have confidence in, a small incision on the bottom portion of your columella, which typically heals extraordinarily well and can be very well invisible is a very small price to pay for a harmonious and natural appearing nose.

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