Dr. Serhan Derin, born in 1982, is a seasoned ENT specialist who graduated from Ankara University School of Medicine. He completed his residency at Kocaeli University in 2010. Dr. Derin is a highly skilled surgeon specializing in functional and cosmetic nose surgeries, including Primary Rhinoplasty, Revision Rhinoplasty, Ethnic Rhinoplasty, Septoplasty, Septorhinoplasty, Nasal Valve Surgery, and Sinus Surgery.
When it comes to nose jobs, there are two main methods to choose from: open vs closed rhinoplasty. But what’s the deal with these two methods, and which one is right for you? Let’s take a closer look!
People swear by the open method because it’s more precise, while others prefer the closed method because it leaves no visible scarring. Ultimately, the cost is considerably similar for both methods, making the decision easier and healthier.
Open and closed rhinoplasty indicates the two existing approaches to rhinoplasty that differ in incision types and recovery process. Since each has its benefits and drawbacks, at the end of the day, it’s up to you and your surgeon to decide which one is the best fit for you. Shall we begin?
What is the difference between open and closed rhinoplasty?
The differences between open vs closed rhinoplasty are not many when you think about the outcome you get from these two approaches. However, you might want to consider the differences in incisions and the recovery period these operations offer. These differences are:
Open (external) rhinoplasty is done through several incisions allowing the surgeon to open up the nose almost entirely. This approach makes it very easy for complex operations. The downside of this approach is that the incisions on your nose may cause scarrings. But don’t worry, because they fade in time if you take good care of them.
Closed (endonasal) rhinoplasty, on the other hand, needs fewer incisions and they are done inside the nose making it a scar-free process. Closed rhinoplasty also has a much shorter recovery length. However, not every surgeon has the skill to perform this approach because it is not a commonly taught technique.
Surgical techniques: behind the scenes
An operative algorithm might be used to decide which incisions, approaches, and techniques should be used in the surgery. However, at the end of the day, the most important factor in selecting the approach is the patient’s anatomy.
If we are to compare these two approaches technically, open rhinoplasty involves:
- Making external incisions on the columella
- Making additional incisions within the nostrils
- Fully opening and exposing the nose
- Closing the incisions with sutures after the procedure
- Correcting various nasal deformities, including asymmetric nasal tip, crooked, saddle nose, cleft lip nasal deformity, septal perforation repair, and complex revision nose job requiring structural grafting.
And for closed rhinoplasty involves:
- Making incisions only within the nostrils
- Not entirely opening the nose
- Providing limited visibility
- Leaving no visible scars or external sutures
- Conservative profile reduction, conservative tip modification, selected revision rhinoplasty patients, and other conservative changes.
Recovery process: a path to healing
There is not much of a difference between open vs closed rhinoplasty when it comes to the recovery process. Both approaches may take approximately a week or two to heal. But still, there are some things worth mentioning as to what you will encounter after the surgery.
After getting an open rhinoplasty, you will be walking around with bandages on your nose and tampoons inside your nose. It is up to your doctor to decide when to remove the bandages but it normally takes a week.
You will go through bruising, swelling, and nasal congestion. You might also experience some amount of dizziness, and headache. A proper cool compressor application is essential to reduce swelling and pain. Sleeping with your head elevated is also very important since that way you will minimize the blood pressure around your nose.
In comparison to open rhinoplasty, patients of closed rhinoplasty will experience less swelling and bruising since the latter is less invasive.
In either case, after the surgery, a rhinoplasty patient should avoid impacts on the face, excessive sunlight, vigorous exercises, drinking alcohol, blowing the nose, smoking, and swimming.
Furthermore, studies have shown that as part of the recovery period, people who had their rhinoplasty with an open procedure experienced reduced sensation in the upper columella in the first week after surgery compared with preoperative values (1). And for both open and closed rhinoplasty patients, they reduced the sensation in the first postoperative week. The nasal sensation came back after the first month.
Scarring: not that scary
Scarring is one of the most common concerns among rhinoplasty patients. Although the possibility of scarring after the surgery is always present, especially with an open rhinoplasty, recent surgical techniques have the potential to minimize the likelihood of scarring.
With open rhinoplasty, visible scar tissue may form on the site of the incision. However, it is not visible unless you are paying direct attention to the underside of your nose. Fortunately, in the case of closed rhinoplasty, scarring is already minimized due to its less invasive nature.
The reason for scarring associated with an open procedure lies in the incision technique known as trans-columellar incision. This technique requires an incision through the columellar skin allowing the surgeon to fully reveal the internal nasal structure. In comparison to open rhinoplasty, surgeons tend to prefer closed rhinoplasty since the incisions used in this approach are only intranasal hence leaving no visible scars.
Although they are not very common, some complications and risks may be worth mentioning.
Complications
Complications are undesirable outcomes of any surgery that are out of the surgeon’s control. The patient’s individual reaction makes it difficult to have any control over the process of healing from surgical trauma. Complications are always a possibility and can be inevitable at times. Thus, identifying the abnormal manner and responding in time remains the only option for surgeons.
Here are some of the complications you may want to be aware of if you had an open rhinoplasty. In contrast, the possibility of experiencing these complications is lower if you had closed rhinoplasty.
- Bleeding
- Infection
- A negative response to the anesthesia
- Having a hard time breathing through the nose
- Permanent numbness around the nose
- The possibility of an asymmetric-looking nose
- Persisting pain, discoloration, or swelling
- A hole in the septum
- A need for an additional surgery
However, you should know that the patient’s individual aftercare has an important role in avoiding these complications.
Cost: Different methods, same old prices
Many factors are in play when providing a price for rhinoplasty. The price range depends on the surgeon’s expertise, location, and type of surgery.
When compared, closed vs open procedures do not seem to differ that much on the price tag. While an open rhinoplasty may cost anywhere from $7,500 to $20,000, a closed rhinoplasty may cost from $5,000 to $15,000.
However, as we’ve mentioned above, it is impossible to identify specific pricing before consulting your surgeon.
Which one is better: open or closed rhinoplasty
The key philosophical idea is neither open nor closed, but rather the need for structural support preservation and anatomical diagnosis. Based on the techniques and experiences they have acquired over time, the surgeons will determine which approach is more suitable and comfortable for them.
Most people are aware of the fact that there can be instances where a given approach can be more beneficial and thus preferred. Also, a lot of people think that there are some gray areas where both open and closed approaches would be appropriate. Nevertheless, the surgeon’s comfort with a procedure remains the most important factor in selecting the approach that will be used.
Let’s maximize the advantages of closed vs open rhinoplasty!
Advantages of open rhinoplasty
External rhinoplasty (open) maximizes surgical exposure, providing the surgeon with improved accuracy in anatomic diagnosis. The external approach also increases the accuracy of precise tissue manipulation, suturing, and grafting.
In addition to having better results at visualizing the nasal anatomy, the open procedure gives surgeons the opportunity to place complex nasal cartilage grafts more precisely and accurately. Furthermore, in another study, it was established that an open approach can help reduce the revision rates in patients who have acute nasal fractures.
Advantages of closed rhinoplasty
Maybe the biggest advantage of the closed approach is that it does not cause any external scarring since it is a less invasive procedure.
Less dissection, less edema, and less recovery time are among the other advantages of closed rhinoplasty procedures. The closed technique can be preferred in cases where edema on the nasal skin must be prevented. Another study has shown that surgeons should go for the closed technique to utilize in most patients who don’t have significant deviation, destruction, or exposure of nasal anatomy.
What makes a doctor decide on open or closed rhinoplasty?
It is difficult to find a single answer when deciding which type of rhinoplasty approach one should get. It mostly depends on the surgeon’s preference and the patient’s specific needs.
The goals and anatomy of each patient must be carefully considered. A skilled rhinoplasty surgeon will have in his or her pocket the open and closed rhinoplasty techniques to offer the patients and acknowledge the importance of maintaining or adding structural support for improving long-term outcomes.
The decision for a particular patient ultimately comes down to the surgeon’s personal assessment of which strategy will, in their experience, offer the greatest likelihood of long-term success with the least amount of surgical dissection.
How should I know if I am eligible for closed or open rhinoplasty?
Unfortunately, it is not possible to decide which rhinoplasty approach to have without consulting a doctor. Your doctor will evaluate your situation based on your goals, your nasal anatomy, the types of deformities you have, and even your psychological state. But still, we can mention a few types of indications to give you an idea.
Important signs that you are eligible for an open procedure:
- Asymmetric nasal tip, crooked nose deformity, saddle nose deformity, revision rhinoplasty requiring complex structural grafting, and complex revision rhinoplasty.
A closed procedure might be your solution if you need:
- Conservative profile reduction, conservative tip modification, selected revision rhinoplasty patients, and other conservative changes.
In addition to these, your medical history will be examined by your doctor during the preoperative evaluation no matter if you are getting an open rhinoplasty or closed rhinoplasty. You will take some tests for general health to see if you are suitable for such a surgery. For both open vs closed rhinoplasty, smoking is a big risk because it increases the likeliness of severe bleeding. Therefore, if you are a smoker, your doctor will ask you to stop smoking two weeks prior to the surgery.
References:
(1) Okur Mİ, Gökdemir O, Karasu N, Yildirim AM. Comparison of nasal senses following open and closed rhinoplasty. Turk J Med Sci. 2016 Feb 17;46(2):287-90. doi: 10.3906/sag-1405-52. PMID: 27511486. Link
-Cash TF, Horton CE. Aesthetic surgery: effects of rhinoplasty on the social perception of patients by others. Plast Reconstr Surg. 1983 Oct;72(4):543-50. PMID: 6611780. Link
-Gupta R, John J, Ranganathan N, Stepanian R, Gupta M, Hart J, Nossoni F, Shaheen K, Folbe A, Chaiyasate K. Outcomes of Closed versus Open Rhinoplasty: A Systematic Review. Arch Plast Surg. 2022 Sep 23;49(5):569-579. doi: 10.1055/s-0042-1756315. PMID: 36159386; PMCID: PMC9507448. Link
-Inanli S, Sari M, Yanik M. A new consideration of scar formation in open rhinoplasty. J Craniofac Surg. 2009 Jul;20(4):1228-30. doi: 10.1097/SCS.0b013e3181ace082. PMID: 19553831. Link
Rettinger G. Foreword complication or mistake? Facial Plast Surg. 1997 Jan;13(1):1. doi: 10.1055/s-2008-1064460. PMID: 9243974. Link
– Cafferty A, Becker DG. Open and Closed Rhinoplasty. Clin Plast Surg. 2016 Jan;43(1):17-27. doi: 10.1016/j.cps.2015.09.002. PMID: 26616691. Link
