Not an Open-Or-Shut-Case - Open Rhinoplasty vs. Closed Rhinoplasty

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Rhinoplasty, or a nose job as it commonly referred to in layman's terms, is a type of nasal plastic surgery that involves the alteration, correction and improvement of the size, shape and features of the nose. (1) Patients who undergo rhinoplasty usually do so for either aesthetic or medical reasons but also sometimes for both.

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Rhinoplasty can be divided into two types of surgical procedures: endonasal rhinoplasty (closed approach (2)) and external rhinoplasty (open approach). The chief difference between the two procedures is that external rhinoplasty involves making a small incision on the columella, the soft tissue between both nostrils, while endonasal rhinoplasty forgoes this step.(3)

Endonasal Rhinoplasty

Endonasal Rhinoplasty or closed rhinoplasty simply means that any and all surgical incisions are made inside of the nostrils. The main benefit of this is that the incisions cannot be seen externally and there will be no visible scars once healed (4). This surgical procedure also involves one less incision than open rhinoplasty, which means it takes less time to complete and there is less swelling during the recovery process.(5)

The drawback of this approach however, is that repositioning the nasal skin after is made much more difficult due to the fact that the incisions made in the left and right nostrils are disconnected.(6) Also, due to limited visibility during the operation, the surgeon has less control and precision to manipulate the nose to a certain aesthetic.(7)

External Rhinoplasty

External Rhinoplasty as the name suggests, is an open approach to nasal surgery. This procedure involves making a small bridging incision called a trans-columellar incision, which connects the right and left nostrils. This allows the surgeon to fold the nasal skin upward, giving them ample visibility to manipulate the nasal skeleton.(8) This is the biggest advantage external rhinoplasty has over endonasal rhinoplasty as it affords the surgeon a clear and visible surgical field on which to assess the issue and correct it. The surgeon is allowed more control and precision, which better allows them to better reshape the nasal bone.(9)

The main drawback of external rhinoplasty is that due to the additional external incision, there is a higher chance of bruising and swelling during the recovery process and there might be some scarring however minimal.(10)

Deciding on which approach to take will be a decision that both you and your doctor will have to discuss, depending on what your needs and requirements are. As with most surgeries, there are benefits and drawbacks to each surgical procedure so don't be afraid to stick your nose in and ask those hard-hitting questions. It also doesn't hurt to nose around on the internet and read up on rhinoplasty procedures. If nothing else, at least you'll be equipped with enough information to follow your nose when you decide it's time to make that appointment.


1 Andrew Frankel, Dr., "What's the Difference Between Open and Closed Rhinoplasty?", in Dr. Frankel - Changing the Face of Plastic Surgery", published July 10th, 2015, viewed on July 1st, 2018, https://www.rhinoplastyrevisions.com/blog/whats-the-difference-between-open-and-closed-rhinoplasty
2 "Open vs. Closed Rhinoplasty", in Richard Davis MD FACS, The Center for Facial Restoration", viewed on July 1st, 2018, http://www.davisrhinoplasty.com/open-vs-closed-rhinoplasty.html 3 Winters, Dr., "Types of Nose Surgery: Open vs. Closed Rhinoplasty", in Cohenwintersplasticsurgery.com, published April 27th, 2018, viewed on July 1st, 2018, https://www.cohenwintersplasticsurgery.com/types-of-nose-surgery-open-vs-closed/
4 ibid
5 op. cit, http://www.davisrhinoplasty.com/open-vs-closed-rhinoplasty.html
6 op. cit, http://www.davisrhinoplasty.com/open-vs-closed-rhinoplasty.html
7 op. cit, https://www.cohenwintersplasticsurgery.com/types-of-nose-surgery-open-vs-closed/
8 op. cit, http://www.davisrhinoplasty.com/open-vs-closed-rhinoplasty.html
9 op. cit https://www.cohenwintersplasticsurgery.com/types-of-nose-surgery-open-vs-closed/
10 Winters, Dr., "Types of Nose Surgery: Open vs. Closed Rhinoplasty", in Cohenwintersplasticsurgery.com, published April 27th, 2018, viewed on July 1st, 2018, https://www.cohenwintersplasticsurgery.com/types-of-nose-surgery-open-vs-closed/

Published: 2018-10-22

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