Overview of Rhinoplasty
Before considering an open or closed approach to rhinoplasty, it’s important to understand exactly what this operation is: a rhinoplasty is a set of surgical enhancements to the nose, to improve upon one or a number of issues. Although a rhinoplasty is most often a cosmetic procedure, there can be medical benefits to aspects of this surgery as well, including the ability to breath better.
Reasons for an open or closed rhinoplasty
Regardless of the technique used, here are some of the most common reasons patients ask for a nose job. Many rhinoplasty patients are unhappy with the nose they were born with, and some are looking to correct changes to their nose from injuries such as a sports injury or car accident. Often patients tell us they feel their nose:
- Is not the right size or proportion for their face (either a nose that is too large or too small)
- Has a bump on the bridge of the nose
- Seems too wide for their face
- Has an issue with the tip of the nose, including a bulbous, protruding, drooping, or over-sized nasal tip
- Has nostrils that are either flared or pinched
- Is crooked or asymmetrical
These factors can be corrected with rhinoplasty.
Changes made during an open or closed rhinoplasty
During any rhinoplasty, the surgeon lifts up the skin of nose, makes changes to bone and cartilage, and puts the skin back down. The art and science of customizing each rhinoplasty happen when the surgeon carefully decides exactly how the bone and cartilage will be altered to achieve the patient’s goals.
Differences Between Open VS Closed Rhinoplasty
It is important to know the differences in open or closed rhinoplasty. In rhinoplasty, the bone and/or cartilage will be altered, and there are only two ways to access these structure of the nose so Dr. Rahban can make the necessary changes: open and closed. During the closed rhinoplasty approach, 2 incisions are made within the inside of the nose. It is through these incisions that all alterations will be made.
An open rhinoplasty includes the same two incisions, but with one additional incision connecting the two, across the columella. That final connecting incision is called a trans-columellar incision, and it allows Dr. Rahban to open the skin of the nose - or unveil the nose. Depending on what the surgeon is trying to do, each approach has its advantages and disadvantages.
Advantages of an open rhinoplasty
The ability to open up the nose in an open rhinoplasty, allows the surgeon to actually see the anatomy underneath. Dr. Rahban believes that given today’s modern and detailed techniques he likes to use, the open approach is often the better choice for three reasons:
- An open rhinoplasty allows you to measure and truly analyze the anatomy of the nose. A true expert in rhinoplasty, Dr. Rahban spends substantial time examining and understanding the anatomy of each person’s nose, so he can do the most detailed and accurate of work. An open rhinoplasty gives the surgeon the ability to see any asymmetry or abnormalities that were not clear from an external examination.
- Beyond being able to better see the anatomy of the nose, the open rhinoplasty allows the surgeon to be much more precise. Given that the nose is such a prominent feature, and such a delicate structure, the more precision in a rhinoplasty, the better.
- The final advantage of an open rhinoplasty is that in the case of Dr. Rahban’s surgeries - he tends to use advanced cartilage grafting techniques for many of his cases. With an open rhinoplasty he is better able to - and more accurately - place the grafts which give more long term support and structure.
For these reasons, an open rhinoplasty lends itself to better access and better results.
Disadvantages of an open rhinoplasty
Those who do not like using open rhinoplasty tend to cite two reasons for this. First, an open rhinoplasty results in a scar because of the trans-columellar incision. While this is true, the scar heals so well in most cases, that it becomes virtually invisible.
After this patient’s open rhinoplasty, her scar is virtually invisible.
The second often-cited disadvantage of an open rhinoplasty, is that many people say there tends to be more swelling than with a closed rhinoplasty. While it is true there is generally some more swelling with an open approach, Dr. Rahban believes that the advantages in terms of the accuracy and level of detail, well-outweigh a little extra swelling that is short term.
Advantages of a closed rhinoplasty
Although Dr. Rahban prefers an open approach in many cases, he believes a closed rhinoplasty can be a very viable approach as well. Dr. Rahban has performed many rhinoplasties both open and closed, and says where only a small amount of work is warranted, a closed rhinoplasty may be a good choice.
Although the scar with an open rhinoplasty becomes almost invisible in many patients, the closed rhinoplasty does have the advantage of having no scar. Additionally, a closed rhinoplasty has a short term advantage of having somewhat less swelling during the recovery period. If your nose job can be done closed, it is worthwhile to have the conversation about whether this option makes sense for you.
Disadvantages of a closed rhinoplasty
A closed rhinoplasty may be a good choice for some patients who need a minimal amount of work done. However, in treating thousands of patients, Dr. Rahban finds that often people need more work done on their nose than they think. In many cases a patient will ask for what seems like a small cosmetic change, but learns their request may involve a more significant amount of detail-oriented work.
Dr. Rahban is especially committed to creating the foundation of a nose job that will last well through the aging process, instead of making quick cosmetic changes with only short-term benefits. During a detailed private consultation, many patients come to realize that even the small cosmetic change they’re requesting, has greater implications on the nose’s structure and architecture, to give them the results they seek. A closed rhinoplasty, in many cases, does not provide the visibility or access to allow a surgeon to perform the most detailed and accurate of bone and cartilage enhancements.
Reconstructive vs reductive rhinoplasty
One important consideration when thinking about open vs closed rhinoplasty, is whether your nose job will be reconstructive or reductive. A reductive rhinoplasty involves removing from the nose. This is more common in patients who feel their nose is too large for their face.
A reductive rhinoplasty - which can be done closed in some cases - is somewhat more simple in technique, compared to a reconstructive rhinoplasty. A reconstructive rhinoplasty often involves Dr. Rahban’s most advanced techniques, and is best performed as an open procedure. With the amount of work needed for a complex reconstructive surgery, open rhinoplasty gives the visibility and access necessary to do comprehensive work on each part of the nose’s structure.
FAQs About Open VS Closed Rhinoplasty
How visible is the scar in an open rhinoplasty?
The scar created in an open rhinoplasty is from the trans-columellar incision. This small incision is made between the nostrils. If this incision is closed well, after healing most patients find this scar is practically invisible. Dr. Rahban always closes his trans-columellar incision himself, which helps to ensure this scar under the nose will heal very well.
From a clinical standpoint, this area between the nostrils seems to be one of the best areas on the face for healing, so as long as the incision is closed well, it is very unlikely people will see it.
Open rhinoplasty: trans-columellar scar is not visible
Does skin color affect whether an open vs closed rhinoplasty should be performed?
Sometimes patients ask us if any particular skin color is more likely to have a visible scar from the trans-columellar incision of an open rhinoplasty. The answer is no. Both light skin and dark skin patients find that the small scar created during an open rhinoplasty, usually heals so that it is virtually invisible. The primary deciding factor in open vs closed is what specifically will be changed in the nose.
What is the difference in recovery between an open and closed rhinoplasty?
A closed rhinoplasty will often have slightly less swelling during the recovery period, but overall the recovery is similar. Regardless of the type of nose job you have, the first week will often include swelling, bruising, and feeling like your nose is stuffy. Most patients do not describe their recovery process as painful, but it is normal to be uncomfortable.
You should improve after the first week, but can expect to have several weeks of swelling. Some patients have more bruising and swelling than other - regardless of whether an open or closed rhinoplasty is performed. These side effects can depend on how extensive your nose job was, your genetic predisposition to heal quickly, and lifestyle choice you make during recovery. For instance, patients often find that sleeping with their head elevated, eating nutritious and low-sodium food, and not pulling clothes over their heads, can all help reduce swelling and make recovery easier.
How are the results different in an open vs closed rhinoplasty?
If a highly skilled and experienced rhinoplasty surgeon believes that your goals can be achieved through a closed rhinoplasty, these results should not be any lesser than they would be with an open rhinoplasty. However, remember that an open rhinoplasty allows for a much larger range of work and precision. For most patients, if they were to say they only wanted a closed rhinoplasty, they would be limiting their potential results since Dr. Rahban would not have full access to analyze their anatomy and use the advanced grafting techniques many of his patients want.
When you’re considering a rhinoplasty, you may be wondering if an open vs closed rhinoplasty is the best choice for you. While these two types do differ, choosing open vs closed should not be a priority in your initial search. The skill and experience of the surgeon you choose will have far more of an impact on your rhinoplasty results, compared to whether that operation is open or closed. If you would like a comprehensive private consultation with Dr. Rahban, please contact our offices for arguably the best rhinoplasty Los Angeles has to offer.
Come in for a Consultation with Dr. Rahban
When Dr. Rahban does a consultation with a prospective patient, he wants it to be two things above all others: thorough and honest. He will find out from you just what you want from cosmetic surgery. And he will tell you honestly if you can get the result you want, and how he can best help you do so.