Rhinoplasty: Open vs. Closed
Because I’m known among Boca Raton plastic surgeons to be board certified in both Plastic Surgery and in Otolaryngology/Head & Neck surgery, I tend to perform many rhinoplasty and revision rhinoplasty procedures every year. In fact, I love performing rhinoplasty procedures, because it’s a great combination of both art and surgical skill. Patients often aren’t aware that there are actually two types of rhinoplasty procedures; the open and closed methods.
Rhinoplasty is a difficult procedure for plastic surgeons. In fact, many plastic surgeons do not perform rhinoplasty surgery because of the unpredictable nature of noses! Here are some reasons why rhinoplasty is considered the most complicated plastic surgery procedure:
- A rhinoplasty procedure involves cutting and/or shaving bone, and moving and reshaping cartilage. Unfortunately, bone can regrow following a rhinoplasty procedure, and cartilage can droop, bend, and warp. These are the reasons that about 20% of all rhinoplasty surgeries are redone every year.
- Skin thickness can dramatically affect results: very thick skin doesn’t contract as well as thinner skin, and may not shrink appropriately after corrections have been made in the underlying nasal structure. Very thin skin, on the other hand, contracts very well but has trouble hiding even tiny postop irregularities in bone or cartilage.
- Tips can be a challenge, even in the most experienced hands, as they can vary from extremely wide or prominent, to a recessed tip or one that is overturned up or down.
- Rhinoplasty surgery, whether open or closed, involves operating in an extremely small space.
- Final results often take up to a year to be visible once swelling has gone down.
The closed rhinoplasty procedure is the most common rhinoplasty procedure performed across the US, including here in Boca Raton. Rhinoplasty was, until the 1990s, performed only as a closed procedure in America, even though the “open” rhinoplasty technique had been done in Europe since the 30’s. In a closed rhinoplasty, all corrections are done through the nostrils. There are no external incisions and, therefore, no external scars. Both the procedure and recovery time afterwards are shorter with a closed rhinoplasty. However, a closed method isn’t the best solution for everyone. Hence, I perform both closed and open procedures, depending upon the specific anatomic structure of each patient’s nose.
In an open rhinoplasty, a tiny incision is made in that little vertical tag of tissue called the columella. It allows me to easily see the lower half of the nose, which is where most nasal corrections are focused, by being able to “open the hood” of the nose. Once I can see what’s happening with my patient’s cartilage, I can modify it through shaving, reshaping, and adding grafts to maintain the final structure. After adjustments have been made, I close the incision with tiny sutures so that the resulting scar is as invisible as possible.
For patients with these nasal characteristics, a closed rhinoplasty is usually appropriate:
- The nose is not overly long and does not have a drooping tip
- Any hump present is small in nature
- The nasal tip is well-shaped, i.e., not too wide and not uneven in size
- The nasal tip is neither over- or or under-projected (the distance of the tip from the face)
Obviously, patients who have a very long nose that requires shortening; a flattened nose that requires support from a graft; a tip that droops or is too wide, asymmetric or tipped up too much; or a large hump in the nose, are often better served with an open rhinoplasty, as are revision rhinoplasties. The final decision is made at your plastic surgery consultation after I have thoroughly examined your nose and listened to your concerns.
The best way to know if you need an open or closed approach is to consult with me at my Boca Raton plastic surgery practice. The primary decision in a rhinoplasty from the patient’s viewpoint isn’t whether the surgeon recommends open vs closed but the skill and artistry of the surgeon himself. I’ve performed hundreds, if not thousands, of rhinoplasty procedures for men and women from Boca Raton, Wellington, Miami, Ft Lauderdale and West Palm Beach. Rhinoplasty is an intricate, exacting operation that must be performed by an experienced, skilled plastic surgeon, as the results are there for the world to see.