What Is the Difference Between Open and Closed Rhinoplasty?

posted on:
August 7th, 2023
posted by:
Dr. Thomas Bell, MD

People decide to undergo rhinoplasty for several reasons.

Some don’t like the prominent bump on their nasal bridge, some have an unwanted bulbous tip, an over-projected nose, or a nose that is too long, and others want to rectify long-standing breathing difficulties.

A rhinoplasty corrects aesthetic imperfections by altering the size and shape and can also be used to resolve nasal breathing issues.

If you’ve looked into your options for rhinoplasty surgery, you’ve likely come across the two different rhinoplasty techniques: open and closed (also called external and internal).

Simply put, the two rhinoplasty approaches cater to the different nasal anatomical features and the desired results. For example, if surgery is being performed to rectify breathing difficulties, a different technique will be required for patients who want their nasal tip realigned.

So, which is the right type of rhinoplasty for your needs?

What is Rhinoplasty?

Rhinoplasty is one of the most popular types of cosmetic plastic surgery available today, consistently reigning within the top-five procedures performed annually among men and women.

Rhinoplasty can transform a person’s entire face, improving its symmetry and overall aesthetic.

One of the things that makes rhinoplasty so popular is how customizable and personal each procedure is. No two noses are the same; thus, no two rhinoplasty procedures are ever fully the same. There are even multiple types of rhinoplasty to further the customization of the procedure, such as open rhinoplasty and closed rhinoplasty.

In this blog, we will take a further look into many open vs. closed rhinoplasty and answer questions, such as “how does closed rhinoplasty work,” “what is open rhinoplasty,” and “what is the recovery like for both.”

Open Vs. Closed Rhinoplasty: Which Technique Is Best?

Before we dive into which technique is best for your rhinoplasty, patients need to understand how each approach works.

A closed rhinoplasty (aka endonasal, or internal nose job) was the first method of nose surgery and involves small incisions inside the nasal lining, which allows alterations through the nostrils without lifting back the skin.

Conversely, an open rhinoplasty is more modern and difficult and involves a small incision on the columella – the outside skin that separates the nostrils – to allow the surgeon to lift the skin of the nose off the tip, like lifting the hood of a car to work on the engine. The open rhinoplasty allows your surgeon unparalleled access to the underlying bone and nasal tip cartilage.

It’s impossible to provide a one-size-fits-all answer to the question, “which technique is best?” – each technique has its own set of benefits that are better suited to certain scenarios. Below we will discuss open and closed rhinoplasty and which procedure is best for you.

Open Rhinoplasty

An open rhinoplasty (also known as external rhinoplasty) involves a small incision at the nose’s base. From here, the nasal skin is lifted above the tip cartilage structure, allowing for better visualization, access, and more significant reshaping and structural graft support capacity.

This technique is recommended for patients who want to change the size of their nose, have a prominent dorsal hump removed, have their nasal tip corrected, or reverse the results with a revision rhinoplasty.

Advantages of Open Rhinoplasty

  • Better access to the nasal structure allows for more reshaping possibilities.
  • The surgeon has greater control and precision.
  • Facilitates reshaping of the nasal tip through intricate suturing or grafting.

Disadvantages of Open Rhinoplasty

  • Lengthier procedure with a longer recovery period.
  • A small scar might remain on your nasal columella (a problem mainly incurred by less-skilled surgeons).
  • More swelling and edema of the nasal tip.
  • Skin discolouration or swelling in the treatment area.

Closed Rhinoplasty

Closed rhinoplasty (also known as internal rhinoplasty) involves making incisions inside the nose through the lining by working through the nostrils. The less-intrusive method is most commonly used to address concerns regarding obstructed airways, minor tip problems, or reducing a bridge bump.

While this technique does have its uses, it isn’t recommended to correct drastic changes or intricate work on the nasal tip. Because of the narrow surgical openings, visibility and access to the underlying nasal structure are limited.

Advantages of Closed Rhinoplasty

  • A simpler and less invasive procedure means less swelling and bruising post-procedure.
  • Shorter recovery period for patients.
  • The procedure is faster than an open rhinoplasty.

Disadvantages of Closed Rhinoplasty

  • Not recommended for larger noses or more moderate to severe concerns.
  • This approach cannot address major structural issues within the nose.
  • Your results will not be as dramatic as the open technique.
  • Obstructed airways or improper healing inside the nose.
  • Limited changes are possible due to the limited visibility of the nasal structure. Combining the open and external approach to correct nasal bridge concerns, such as bumps and aesthetic nasal tip changes, is not uncommon.

Key Differences Between Open and Closed Rhinoplasty

The key differences between open and closed rhinoplasty predominantly concern each procedure’s purpose, incisions, risks, and recovery.

Recovery Time

While an individual’s recovery time will vary depending on person to person, closed rhinoplasty recovery generally takes between one to two weeks. Most patients recover in one week, and after the 6th day, your splint can be removed. Open rhinoplasty can take a little longer to heal swelling and bruising, but overall the recovery period is not much longer when compared to closed rhinoplasty.

Purpose

The type of rhinoplasty you seek out depends on your goals and the severity of your concerns. Open and closed rhinoplasties serve different purposes. Closed rhinoplasty modifies the nasal bone and cartilage through reduction, reshaping, and/or augmentation, perfect for refining the nose tip and reducing any bumps or crooks.

Open rhinoplasty allows for bigger adjustments, such as changing the nose top, fixing a broken nose, making major cartilage changes, or adjusting your side profile/facial symmetry.

Side Effects

When you’re in the hands of a professional like Dr. Bell, the chance of risk is very low. Some rare risks that you should be aware of include:

  • Bruising.
  • Swelling.
  • Blocked nasal airways.
  • Nasal bleeding.

These are often your body’s natural reaction to the procedure and healing process, but they will subside within a few days. If these symptoms last longer than one week or your breathing is severely impaired, contact the TPS team or your general practitioner.

Incisions

All incisions are made inside the nostril with a closed rhinoplasty so they are invisible during healing and when healed. With an open rhinoplasty, incisions are made on the skin between the nostrils, meaning it is an extremely minimal external scar. Once healed, the scar will either be completely invisible or barely visible.

Which Surgery is Right for Me?

Open and closed rhinoplasty have their own positives and downsides. The surgery that is right for you depends entirely on the approach you want, the severity of your concerns, and your aesthetic goals. When you visit Dr. Bell and the TPS team, their expertise will guide and educate you before, during, and after your procedure. Whatever surgery method you choose, you can rest assured that you will leave the clinic with beautiful results that will continue to improve.

Schedule a Consultation

The specialists at Toronto Plastic Surgery are in the best position to help you make the right rhinoplasty choice. Schedule a consultation with us today to find out how our tried and tested techniques work to give you outstanding results.

Posted by:

Dr. Thomas Bell, MD

Dr. Thomas Bell has been one of Canada’s most renowned cosmetic surgeons for 35 years. He prides his excellence on the harmonious balance of vision, aesthetic appearance, and patient care.

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