Before answering this question, it’s important to define what open rhinoplasty and closed rhinoplasty are. Closed rhinoplasty, also referred to as endonasal rhinoplasty, is a rhinoplasty procedure in which all incisions are confined to the inside of the nostrils, resulting in no visible skin incisions. Once the incisions are made, the skin is lifted from the underlying cartilage and bone and the nose is then recontoured and reconstructed. For open rhinoplasty, also referred to as external rhinoplasty, a very small incision is made between the nostrils on the underside of the nose. This allows the tip of the nose to be opened in order to reveal the structures of the lower and middle third of the nose.
So which is better? Some surgeons strongly believe that the external incision for open rhinoplasty is not necessary for primary, or first time, rhinoplasty procedures. Instead, they think that open rhinoplasty should only be performed for revision cases that are significantly difficult. Other surgeons, however, perform open rhinoplasty on both primary and revision rhinoplasty procedures.
Both groups may be right. The appropriate approach – be it open or closed – really depends upon the complexity and difficulty of the particular patient’s nose as well as the surgeon’s level of experience and skill. Some surgeons are very skilled at open rhinoplasty, favor this approach for most cases, and achieve excellent results. Other surgeons favor closed rhinoplasty and are able to achieve excellent results with this approach.
When determining which approach is right for you, it’s important to focus on your satisfaction with the surgical result. Most patients would like prefer the procedure that results in no visible scarring, but it’s important that you not select your surgeon solely because he or she favors one approach over another. The emphasis should not be on whether or not you have a resultant scar, but on the whole of the surgical result. After all, the incision required for open rhinoplasty is a small one on the underside of the nose that typically heals into a nearly invisible, fine-line scar. It’s certainly a small price to pay, if necessary, for a harmonious and natural appearing nose.
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