Open Rhinoplasty vs. Closed Rhinoplasty

Rhinoplasty consists of modifying the bones and cartilage of the nose to achieve the desired nasal shape and size. “Approach” is a term used by surgeons to describe a path taken to access the area to operate. For rhinoplasty, open approach or closed approach describes different ways surgeons access the bones and cartilages of the nose in order to modify them into an aesthetically pleasing and functional nose.

Open Rhinoplasty Surgery

The steps of an open rhinoplasty approach consist of:

1. Incisions are made inside the nostrils as well as on the skin of the vertical partition between the two nostrils.

2. The skin is then peeled off the tip and the bridge to expose the cartilage and bones of the nose.

3. The bones and cartilage are then altered into a new shape that will refine the nose.
   • Because some parts of the nasal anatomy are taken apart and weakened when the skin is peeled off, including the structures that hold the tip in its place, they need to be rebuilt and repaired.
4. Cartilage is taken from inside the nose or, in some cases, from the ears to repair and reconstruct the weakened anatomy.
5. The skin is put back in place and sutures are placed to close the incisions. These are removed a week after surgery.
6. A dressing and a splint are usually placed over the nose to protect it during the recovery period.

Closed Rhinoplasty Surgery

The steps of the closed rhinoplasty approach consist of:

1. Incisions are made inside the nostrils only. No incision on the skin is necessary with this approach.

2. The bones and cartilage of the nose are accessed by passing instruments under the skin without peeling it off the nose. Imagine the surgeon’s instrument like a “mouse under a rug.”
3. The only areas accessed are those that are being modified, rather than lifting the skin off most of the nose, which is done during the open rhinoplasty technique.

4. The modifications and alterations to the bones and cartilage are performed under the skin. The rhinoplasty surgeon is able to see the structures inside the nose by looking through the incisions and making the necessary modifications.
   *After each step and each alteration, the surgeon is able to look at the nose from the outside to evaluate the effect of the alterations performed and judge, on the spot, if more cartilage or bone needs to be removed.
5. Dissolvable sutures are used to close the incisions inside the nose.
6. A dressing and a splint are usually placed over the nose to protect the area during recovery.

Advantages of Open Rhinoplasty

While it is true that it is easy to teach and demonstrate the anatomy and maneuvers in an open rhinoplasty, it does not hold true that the surgeon is more able to “see” the anatomy while preforming the procedure.

Disadvantages of Open Rhinoplasty

There are some disadvantages to using the open approach.

1. One of the biggest reasons patients opt for a closed rhinoplasty is because the open approach leaves a small external scar. However, if the incision is sutured appropriately and discreetly, the scar should rarely be visible once it’s fully healed. Unfortunately, that is not always the case.

2. Some of the structures that support and “prop up” the tip of the nose are weakened because there is a more significant degree of cutting and manipulation of tissues. To make sure the tip does not droop, the surgeon needs rebuild this weakened nasial anatomy by placing cartilage grafts taken from elsewhere in the nose or from the ears.
3. The operation takes longer, usually 3 hours or more. This means longer time under anesthesia. In addition to this, longer surgical times often means more swelling and it becomes more difficult for the surgeon to see the fine detail as they modify the nasal structures.
4. The surgeon can have a hard time judging the effect of the maneuvers made to the nose during surgery. For example, when the surgeon reduces the size of the cartilage during an open rhinoplasty, it is difficult to immediately look at the nose and determine whether the amount removed was sufficient or if more needs to be removed, due to the nose being “dismantled.”
5. The swelling after surgery is often greater and takes longer to fully resolve, resulting in a prolonged recovery period.

Advantages of Closed Rhinoplasty

1. There is no visible scar. Although the scar on the skin associated with open rhinoplasty heals well when properly and carefully closed, it remains an additional factor. Like any surgical scar, it can occasionally cause added complications, including healing poorly.
2. Closed rhinoplasty is less “invasive” because there is less manipulation and trauma to the tissue. Most importantly, the natural nasal supports are preserved, rather than cut and weakened.
3. The surgical time is shorter, meaning that there is often less swelling during and following the procedure.
4. The rhinoplasty surgeon is able to immediately see the effect of every maneuver performed, whether it’s removing a hump, or reducing the cartilage, because the skin envelope is intact rather than peeled off.
5. The nose does not take as long to “set” after surgery, meaning that patients will be able to see their final results sooner.

Disadvantages of Closed Rhinoplasty

The main disadvantage is the expertise and experience required to perform the closed rhinoplasty procedure. However, when the surgeon has acquired this experience, they are able to perform any maneuver or modification required to achieve the desired aesthetic result.

Dr. Samaha’s Approach

Dr. Samaha has experience using both open and closed approaches. However, he feels that the closed rhinoplasty approach is best.

He has thus far performed over 2,700 closed rhinoplasty surgeries and is highly sought after in Montreal for his expertise in rhinoplasty surgery.

The closed approach, in his experience, provides an easier experience for the patient and leads to an overall better result. The ability to sculpt the nose and see the result immediately on the operating table allows Dr. Samaha to obtain more consistent and predictable esthetic results. In addition, aside from the absence of a scar, his patients usually benefit from a very short recovery period with very little swelling and bruising.

Dr. Samaha’s use of the endonasal approach, combined with a sedation anesthetic, are part of an overall minimally invasive approach that yields excellent results with minimum discomfort and recovery.

If you’d like to learn more about the costs associated with nose refinement surgery, visit the rhinoplasty cost page.

We look forward to working with you to create the best rhinoplasty results possible. Request your consultation online or call us at (514) 613-3004. Dr. Samaha attracts patients from Quebec City, Laval, and Gatineau.