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Tag Archives: Otorhinolaryngology

Open or Closed rhinoplasty surgery?

The need to dedicate a whole news report to this topic stems from the question frequently asked in this regard by candidates for rhinoplasty: each candidate for rhinoplasty asks the surgeon a number of details on the operation, and the question concerning the open/closed method is always present.

The difference between open and closed approach

Furthermore, a growing source of information on that matter is to be found in forums, medical websites, and chat rooms.
More information does not necessarily mean better understanding. Judging by some questions that patients ask me during the examination, I would dare to say that it is not always the case.

The difference between open and closed approach can be easily explained by saying that:

  • Open rhinoplasty is a surgical approach involving an incision (and the ensuing scar) across the columella, the strip of skin separating the nostrils;
  • In closed rhinoplasty, all the incisions are made inside the nose: there are no external incisions.

As it often happens with surgery, the growing use of “open” rhinoplasty in Europe derives from an American custom: many surgeons in the US use it as the only nasal surgery method and NEVER use “closed” rhinoplasty.

The explanation seems very complicated and involving a wealth of technical details, but actually it is rather simple. In the United States, only the “open” technique is taught during surgical training programs in Otorhinolaryngology, Maxillofacial surgery, Plastic surgery and Facial Plastic Surgery.

The open technique allows a greater exposure of nasal structures (cartilages, bone, tip, valves), and has a high educational value, whereas the closed technique requires a much longer learning curve, thus involving a manual dexterity in surgery that needs to be more advanced from a technical point of view.

Excluding the type of surgical approach: “open” vs. “closed”, these two rhinoplasty techniques actually share many technical steps and solutions; the differences are but a few.

Therefore, a comparison between open and closed approach is not very useful, either to the surgeons or to the patients, since there is no clear advantage of the one over the other.

Choice should always be based on individual patient factors, the approach should be decided for each individual patient, taking into account:

  • Acquired or congenital deformities
  • Outcomes of major trauma to the nose or face
  • Previous rhinoplasties
  • Need to position grafts and implants in biocompatible materials
  • Associated functional nasal surgery

It can be said that the open approach is well-suited to more “complex” surgical cases, whereas “simpler” cases may be treated through the closed approach.
Whenever possible, the use of the closed technique ensures the patient shorter recovery periods, nose swelling goes down more rapidly and the nose settles into its new shape more quickly.

Who are the best candidates for rhinoplasty

An advice to candidates for rhinoplasty: closed rhinoplasty and open rhinoplasty are not in contrast with one another, and they are not a criterion for the choice of a surgeon.
They both are excellent techniques that have to be deeply learnt, combined together and applied depending on the individual needs of each surgical case.