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Which is better—open or closed rhinoplasty?

Rhinoplasty or nose job, is one of the most popular facial cosmetic surgeries performed in the United States. The nose sits prominently on the face and is a major factor in determining one’s facial harmony and beauty. In addition, the nose serve a vital function in humidifying and warming air when we breathe. One only has to recall when one had a cold to realize how important good nasal airflow is to good quality of life. Despite its popularity, a nose job also happens to be one of the most challenging surgical procedures in facial cosmetic surgery. Every nose is different and requires a detailed plan to achieve desired goals. There are two basic approaches to a rhinoplasty—closed or open. Sometimes, I will get questions on which one is the best technique. The short answer is –both are good, in the right circumstances.

A closed approach is the original technique. Here, all the techniques are performed via incisions made on the inside of the nose. Tip cartilages can be delivered out into the open if tip work needs to be done. The advantage is much less swelling with a closed approach. The disadvantage is limited exposure of the underlying nasal structures. This limited exposure also limits what surgical maneuvers can be done. An open approach is where an incision is made on the columella and extended into the nose, after which the overlying nasal skin is pulled back to expose the underlying nasal structures. The advantage is unparalleled exposure to the nose and ability to do major reconstructive and cosmetic techniques.
Extensive advanced grafting and suturing are easier with the open approach. The disadvantage is increased swelling and prolonged edema when compared to the closed approach.

You will discover that the vast majority of surgeons today are trained in the open approach. It’s harder to find a surgeon who will perform closed approach for rhinoplasties that require tip work or extensive reconstruction. The main reason is not many of us are trained to deliver the tips for routine rhinoplasties. Vast majority of rhinoplasty teachers train surgeons using the open technique because of the great exposure. However, I do feel a closed approach is a good technique when a patient just has an isolated hump deformity that he or she wants taken down. In these cases, I don’t see a great need to open up the nose.

So, the answer to which approach is better is—both are good techniques. It really boils down to which technique reliably delivers the best results for the surgeon. More important than which exposure is better is how experienced is the rhinoplasty surgeon. I’ve seen great results from both experts who do only the open approach and experts who only do closed approach. You should not let the approach decision be the key factor in choosing a surgeon. Just bear in mind—as you’re researching surgeons—that if you prefer a closed approach, you’ll have less surgeons to find and consult.

For more information about rhinoplasty in San Antonio contact Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery. We are a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please call our Concierge Patient Coordinator at (210) 876-6868 today.