To Open Or Not To Open? That, Is The Question! Which Rhinoplasty Approach Is Best For You?

According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), every year approximately half a million people seek consultation to change or enhance the appearance of their nose. With the rise of social media and the abundance of our own photos all over these outlets, that number is only going to rise. As the central point of a person’s face, the size and shape of the nose has a great impact on a person’s appearance.

Rhinoplasty, which is commonly referred to as a “nose job”, is a surgical procedure performed that can dramatically improve or balance facial proportions.  Being a complicated procedure, rhinoplasty has two different approaches: open or closed.

The closed approach is surgery that is done through the nose (endo-nasal). While the open approach is done by making an incision in the columella (the area that separates the nostrils) and elevating the entire skin over the nasal cartilages and bone.

Neither approach is wrong as long as the surgeon who is performing the surgery is comfortable doing both approaches. What I do feel is wrong is making every patient have an open rhinoplasty if they don’t need one. The open approach disrupts many of the stabilizing factors of the tip of the nose, which then have to be reconstructed, grafted or improved.

Open rhinoplasty was designed primarily to perform surgery for patients who have wide tips, tips that need grafting due to previous bad or botched surgery, or need reconstructive surgery for their nose tips. Because of the complexity of rhinoplasty surgery, the open approach has become routine for physicians who find it easier (for them) to perform surgery.

Not all noses are created equal, look equal or need equal treatment. On patients who have a bump along with a very nice nasal tip that needs minimal change, I would perform a closed rhinoplasty procedure. On patients with a wide nasal tip, an over projected (sticking out far from your face) nose, or previous rhinoplasties that need revision, I would perform an open rhinoplasty procedure.

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