For a patient, it can be confusing to understand the difference between open vs closed rhinoplasty. The information available on the internet can, at times, deepen the misunderstanding. This short article aims to provide some basic information and hopefully, help answer some common questions and dispel misunderstanding.
The difference between a closed and open rhinoplasty, in the simplest terms, is the different techniques used to access the nasal bone and cartilage to carry out the modification of these structures, and thus alter the shape of the nose. In closed rhinoplasty all the cuts and incisions are hidden within the nostrils, while in an open rhinoplasty there is a tiny cut on the external skin in-between your nostrils.
The key point to appreciate is that the surgical steps taken by a surgeon after utilising one of these approaches is not linked to the kind of approach – in fact, a surgeon utilising closed rhinoplasty approach could be carrying out identical surgical steps and modification of the bone and cartilage of the nose as a second surgeon utilising an open rhinoplasty approach. It should be noted that the success and failures of rhinoplasty surgeries are in no way linked to the two techniques mentioned – the key considerations in your decision to undergo rhinoplasty surgery should be the surgical experience and technical expertise of your chosen surgeon.
Another common misunderstanding is that closed rhinoplasty is less invasive. If you grasp the key point made above, it will become evident that the invasiveness of the procedure is dependent on the surgical steps taken to modify the nasal bone and cartilage. In fact, many closed rhinoplasty techniques require multiple cuts within the internal nasal lining and can be significantly more invasive than the open rhinoplasty approach.
Another common procedure is preservation rhinoplasty – while there is no universally accepted definition of preservation rhinoplasty, all reduction rhinoplasty surgeries require removal of excess bone and cartilage. One of the common preservation rhinoplasty techniques is used to remove the hump from the nose. The preservation technique does this by removing excess bone and cartilage from under the natural nasal dorsum, while the classical technique does so by directly removing the excess bone and cartilage from the dorsum of the nose. There is no clear evidence to suggest that the outcome of the surgery is different depending on which technique is used; the outcome will depend on the proficiency with which the surgeon utilises either of these methods rather than the type of surgery.
The best way to ensure that you have a successful surgery with an optimum outcome is to carefully consider your choice of surgeon, taking into account feedback from previous patients, the experience the surgeon has, research into their past work (such as before and after pictures they have available), and ensure you have detailed discussions about your preferred goals and outcome. As we have discussed, the approach (i.e. open vs closed rhinoplasty or the labelled technique i.e. preservation vs classical vs minimal invasive) are just nomenclature which does not predict the success of surgery. These also do not predict the postoperative recovery, swelling or bruising. Consultation with anyone other than your surgeon (e.g. a patient facilitator, marketing personnel, a nurse etc) is a high risk strategy and is not recommended.