Two primary methods exist for performing cosmetic rhinoplasty: closed or open. Each has its advantages and disadvantages.
Closed rhinoplasty, otherwise known as endonasal, involves incisions confined to the inside of your nose. There are no sutures to remove. The plastic surgeon can modify or alter any part of the nose, including the tip and hump. Swelling improves earlier and recovery is generally faster. However, for patients who have had previous rhinoplasty or congenital cleft lip, your plastic surgeon may be limited to achieve some changes in your nose because of inability to see parts of the inside of the nose.
Open rhinoplasty involves a small incision across the base of the nose, between the nostrils, otherwise known as the columella. Additional incisions are made on the inside of your nose. Open surgery may be preferred in more complicated rhinoplasty surgeries. Some plastic surgeons prefer the open rhinoplasty approach because it allows greater visibility of the nose. Swelling and bruising usually lasts much longer with this rhinoplasty approach.
Lastly, the method of rhinoplasty is based on the plastic surgeon’s prior training and expertise. When deciding on open vs. closed rhinoplasty, one should follow the advice of your plastic surgeon, and your specific rhinoplasty needs.
My preference has always been endonasal rhinoplasty, as results are more predictable and postoperative swelling much less, as compared to the open approach. I discuss the options with patients, and based on their specific rhinoplasty desires, help develop a treatment that is appropriate for them.