Almost everyone looking into nose surgery comes across the question "open or closed?" first. Online, the two techniques are often presented as rivals. In fact both are established surgical approaches, and the choice is made according to the person's anatomy and the extent of the reshaping.
Closed (endonasal) rhinoplasty
In the closed technique all incisions stay inside the nostrils. There is no incision visible from outside. The surgeon reaches the tissues through the inside of the nose to reshape bone and cartilage.
- Because there is no external incision, there is no visible scar.
- Dissection of the tissue is more limited, so swelling usually subsides more quickly.
- The field of view is restricted, which narrows the surgeon's room for manoeuvre in complex reshaping.
Open (external) rhinoplasty
In the open technique a small incision is added to the narrow strip of skin between the two nostrils, called the columella, and the skin is lifted. This allows the framework of the nose to be seen directly while the surgeon works.
- All the structures are visible; symmetry and supporting sutures can be checked directly.
- It is widely preferred where a cartilage graft has to be placed.
- The scar on the columella fades over time; how quickly it heals depends on the person and on the skin.
- The swelling can take longer to resolve than with the closed technique.
Which is preferred, and when?
Choosing a technique is not a matter of fashion or preference; it is decided by looking at the following:
- The extent of the reshaping: a limited correction of the bridge and a full reconstruction of the tip do not create the same need.
- Anatomical difficulty: marked asymmetry, a previous injury or weak supporting tissue may call for a wider field of view.
- A previous operation: in planning a revision, seeing the structures directly usually becomes important.
- Skin thickness and tissue quality: these affect how healing progresses and how much support is needed.
The answer to "which is better?"
Neither technique is absolutely superior. The right question is not "which is better" but "which is right for my nose". And that can only be answered after an examination, an assessment of the inside of the nose and the planning.
Do not hesitate to ask at the first consultation why a particular technique has been chosen. A plan whose reasoning can be explained clearly also makes the rest of the process predictable.
This article is for general information; diagnosis, treatment and the choice of technique are decided individually only after a medical examination. The timings and processes described here vary from person to person.