Closed rhinoplasty and open rhinoplasty are two generalized terms used to describe approaches that surgeons use to correct the outside of the nose. Closed rhinoplasty is done totally within the nose with no external incisions. In open rhinoplasty, the surgeon uses an incision across the bottom of the nose to increase access to certain areas of the nasal framework. Nathan E. Nachlas, M.D. first described open rhinoplasty in 1985 as the chief resident at Johns Hopkins to an international meeting of facial plastic surgeons. This was one of the earliest talks about this procedure which for the first time allowed surgeons to directly address some of the more complex abnormalities found on the outside of the nose.
Closed rhinoplasty is particularly applicable in patients who have a fairly symmetrical nose, who desire minor corrections to the appearance of the nose, and whose tip of the nose already is in correct proportion. This minimally invasive technique has the advantage of quicker healing and less operative time. It is a procedure done entirely inside of the nose, correcting the framework with small incisions through the internal lining.
Open vs Closed Rhinoplasty
Dr. Nachlas is proficient in both techniques and individualizes his approach for every patient. The open rhinoplasty procedure has advantages for patients with severely deformed noses or significant problems with the tip of the nose. In this approach, Dr. Nachlas can directly sculpt and correct asymmetries in the tip and skeleton of the nose to maximize the structure of the framework.
The disadvantage of the open rhinoplasty is that there is a small incision across the bottom of the nose, which fortunately heals extremely well and is nearly imperceptible within weeks of the surgery. The procedure can take somewhat longer than the closed rhinoplasty approach. Swelling of the nose takes longer to disappear after the open approach. Despite these disadvantages, it is the procedure of choice in patients who meet the indications for open rhinoplasty as addressed above to ensure the best possible long-term result.
Dr. Nachlas will discuss during your consult the applicability of either approach to your situation.