Cosmetic Nose Surgery: Closed Rhinoplasty and Open Rhinoplasty

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Marianne Campolongo, Staff Writer

Marianne A. Campolongo is an experienced writer and photographer. Her work has appeared in newspapers and magazines and on websites. The topics she has written about include health, parenting, lifestyles, travel, food, and dieting. She has also photographed magazine covers, including personalities such as Hillary Clinton and former CBS co-anchor René Syler. She holds a law degree from Fordham University School of Law.


December 31 2007

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Open Rhinoplasty or Closed Rhinoplasty? Which Rhinoplasty Technique is Best for You?
Cosmetic plastic surgeons perform rhinoplasty (cosmetic nose surgery) in one of two ways: open rhinoplasty (also called external rhinoplasty) and closed rhinoplasty (also called endonasal or internal rhinoplasty). What's the difference between these two rhinoplasty techniques and which one is best for you?

Closed Rhinoplasty
In a closed or endonasal rhinoplasty, all incisions are made within the nostrils so there is no visible scarring.

Open Rhinoplasty
In an open rhinoplasty, incisions are also made within the nostrils but there's an additional incision across the columella, the strip of skin below the nose between the nostrils. This tiny incision lets the surgeon open and actually flip up the tip of the nose. This way, the cosmetic plastic surgeon can view the underlying structure of the lower and middle third of the nose.

Scarring and Recovery After Rhinoplasty
In a closed rhinoplasty, there is no scarring outside the nose. So if the rhinopalsty scar is one of your biggest concerns you should ask your cosmetic plastic surgeon about closed technique. The tiny incision across the columella in an open rhinoplasty generally leaves a faint scar. Usually, the rhinoplasty scar is almost invisible after it heals and, since it is underneath the nose, it is usually not noticeable. Ask your doctor how visible your scar will be.

In most cases, you can go home the same day as your nose job surgery regardless of which rhinoplasty technique is used.

You will be bruised and swollen after either type of rhinoplasty and you may have two black eyes. The swelling and bruising should start to subside during the first week, but it can take several weeks to go away and even longer with open rhinoplasty. Either way, sleeping with your head elevated during the week after surgery helps. Please refer to recovery after rhinoplasty for more information.

Closed Rhinoplasty vs Open Rhinoplasty: What Is Right For You
Rhinoplasty or cosmetic nose surgery is one of the most popular plastic surgeries. It is also one of the most complicated plastic surgeries of the face since much of it is done by feel. In both open and closed rhinoplasty the surgeon lifts the skin off the underlying bone and cartilage to reshape the nose.

Depending upon your cosmetic plastic surgeon's preferences, the scope of your surgery may dictate whether it will be open or closed.

Some surgeons find that the closed technique limits the amount of reshaping possible, so they choose open rhinoplasty when they are altering the tip of the nose or performing other more complicated nose jobs. That is because open rhinoplasty makes it easier for them to see and reshape much of the cartilage. Some also believe this technique simplifies achieving a symmetrical tip. There are other plastic surgeons, however, who can achieve excellent results using the closed technique. Other cosmetic surgeons may go in intending to do a closed rhinoplasty and then determine that an open technique is best.

A University of Toronto study of American and Canadian plastic surgeons and otolaryngologists (ear, nose and throat doctors) in 2005 found roughly 65-75% of surgeons preferred the open rhinoplasty technique for difficult tip surgery, revising a previous nose job, and where grafting was needed, but chose closed rhinoplasty for simple procedures on the tip and bridge of the nose. Twenty-three percent preferred open rhinoplasty either nearly all or all of the time.

The Bottom Line
The technique your cosmetic plastic surgeon prefers should not be the deciding factor. Ultimately, you should choose a plastic surgeon whose experience and judgment you trust. It is important to discuss the rhinoplasty technique with your surgeon, but it is even more important to see before-and-after photos of your surgeon's patients who have noses like yours to determine if your surgeon, regardless of the technique he or she is recommending, can give you the results you desire. In the end, most people will choose a surgeon based upon his or her skill and experience rather than his or her preferred rhinoplasty technique.

According to the American Society of Plastic Surgeons, in 2006 the average rhinoplasty cost $3,841. Keep in mind this is just an average. Costs vary widely for the same procedure. Costs also depend upon how complicated the procedure is, with an open rhinoplasty generally costing more than a closed procedure. Rhinoplasty costs are generally not covered by insurance, although reconstructive rhinoplasty may be covered. Fortunately, our cosmetic plastic surgery financing can help.