The difference between an “open” versus a “closed” rhinoplasty is a small (transcolumellar) incision between the nostrils. This incision, when connected to the traditional intranasal incisions within each nostril, allows the skin to be elevated off the underlying framework. This “opens” up the surgical field which has certain benefits, especially when operating on a nose that has been injured or operated on previously. In both of these cases, dissection through scar tissue is easier, evaluating causes of asymmetry is easier, placement of grafts is easier and performing certain suture techniques is easier. I have not seen an increase in swelling or post-operative recovery time with the open technique. And the resultant transcolumellar scar is generally imperceptible over time. On the other hand, unless special care is taken to avoid disrupting the attachments of the tip to the septum, nasal tip support has to be re-instated which lengthens operative time. Additionally, there are special cases where an open rhinoplasty is also useful. These involve procedures where the tip has to be significantly reconstructed or repositioned. Though many of these manipulations can be accomplished using the “closed” technique by an experienced surgeon, they are more easily and more predictably performed using an “open” approach. Furthermore, in the “closed” technique all of the access routes to the bone and cartilage are through intranasal incisions. Because of this, placement of any synthetic implant could be problematic due to the risk of extrusion.
Though I’ve outlined many advantages of the “open” versus “closed” technique, I should state that in a fairly straightforward, primary rhinoplasty, the closed technique is perfectly satisfasctory, predictable and probably most often employed.