Open or closed rhinoplasty: which is best for you
The first depictions of rhinoplasty procedures date to the sixth century BCE, when the Indian surgeon Sushruta described repairing a disfigured nose with a skin graft. Modern rhinoplasty techniques were only introduced in the late 1800s, first with the closed technique, followed by the open technique a few decades later.
Currently, closed and open rhinoplasty are the two main approaches to rhinoplasty. Each method has its unique advantages and considerations.
What is an open rhinoplasty?
During an open rhinoplasty procedure, an incision is made in the columella, the skin between the two nostrils at the base of the nose. The skin is lifted away from the underlying bone and cartilage framework, allowing for complete visualisation of the structures that need correcting.
Significant deviations of the septum can be corrected, and bone, cartilage, or soft tissue grafts can be used to support, shape or augment. The columella skin is then sutured closed.
What is a closed rhinoplasty?
With a closed rhinoplasty there usually are no external skin incisions, as all surgical incisions are made within the nostrils.
It is typically performed for primary rhinoplasties when less drastic changes are required. It can reduce the size or width of the nose if it’s disproportionate to the rest of your face. It can also address asymmetries, unwanted nose bumps or a bulbous or droopy tip.
Mr Annakan Navaratnam on choosing between an open or closed rhinoplasty
“Many patients would prefer a closed rhinoplasty, as there are no incisions, and scarring is an important consideration when contemplating surgery. However, for some patients, an open rhinoplasty is required to get the results you want.
Example of closed septorhinoplasty
“If the nasal tip or middle third is very twisted or there is significant nasal septal deviation, then these would benefit from an open septorhinoplasty. This gives you better access, better control and, typically, a better result.
Example of a significant deviation requiring an open approach
“The drawback is that there is an incision, but it is usually very well hidden. During the consultation, I can show them examples of what the incisions will look like at different time points in the healing process.
Example of the columella incision
“If patients feel they can’t tolerate having a scar, we discuss what we can achieve through a closed approach. For example, you can refine the nasal tip through a specific method called the delivery approach to remove the cartilage.
“This is where shared decision-making comes in, which is fundamental to my approach. I explain to patients the best options, and then we decide together based on their motivation and priorities.
Find out if you’re suitable for an open or closed rhinoplasty. Call +44 (0)203 627 2918 or email secretary@annakan.co.uk to arrange a consultation with rhinoplasty surgeon Mr Annakan Navaratnam.
