Dr. Constantine Blog

There are two main approaches to the nose when performing a rhinoplasty: the “closed” and “open” approach.

“Closed” refers to leaving the skin envelope on the nose during surgery, while “open” refers to lifting the skin off the cartilaginous and boney framework to perform the surgery. This is much like lifting the hood of a car in order to work on the engine. I perform the vast majority of rhinoplasty procedures using the “open” approach for various reasons. There is no “best” way; a surgeons training and comfort with one approach vs the other plays a major role in what type of surgery he/she will perform. Fortunately, I have been trained in both approaches and feel comfortable using either one. Although there are a few drawbacks to the “open” approach, the advantages greatly outweigh the disadvantages and make the end result more consistent, long lasting, and easier to achieve. Below are a few pros and cons to the “open” vs “closed” approach.

Open Rhinoplasty Advantages:

• Allows for complete visualization of the nasal structures and thus complete evaluation of the deformities without distortion of adjacent nasal structures.
• Allows for a proper diagnosis and correction of the problem areas by allowing for more control of the structures and their corrections
• Both hands are totally free for use
• Provides the surgeon with more options with regard to grafting and manipulating the native tissues for proper and accurate shaping of the nose
• Grafts are easily able to be sutured in place for stable fixation

Open Rhinoplasty Disadvantages:

• Small scar on the undersurface of the nose
• Slightly longer operative times
• More post operative swelling (temporary)

Closed Rhinoplasty Advantages:

• No external scar
• Less tip swelling in the immediate postoperative stage
• Slightly less operative time
• Faster recovery

Closed Rhinoplasty Disadvantages:

• Does not allow for direct view of the nasal structures
• Difficult dissection of structures that need manipulating, especially if they are malpositioned
• Often, the surgeon does not have both hands free as one is being used to retract the skin envelope upward

The “closed” approach is reserved for isolated and straightforward problems such as shaving down a large dorsal hump.

Otherwise, the ”open” approach is the preferred method if any major tip work or combination of maneuvers is needed.

Every patient has different nasal characteristics, thus each patient will have a different surgical plan that will need to be executed in order to achieve the desired result. We provide a detailed history and physical examination for each patient and every operation is tailored specifically for his/her needs. Visit with us in our Dallas plastic surgery office and see which operation best fits your needs.