Are you considering getting rhinoplasty? Nose jobs are appealing to many people for a variety of reasons. Some individuals simply do not like the size or shape of their nose and would like to make an adjustment. Others may need rhinoplasty for health-related reasons, such as correcting a deviated septum that has resulted in breathing or other nasal problems. Whatever the reason, rhinoplasty is one of the most popular cosmetic procedures in the United States, but it can also be very complicated.

Rhinoplasty Methods

The nose is extremely complex, and everyone’s nose is slightly different. These differences are, in part, why there are two basic methods for nose reconstructive surgery.

1. The Open Approach: External Rhinoplasty

Both approaches require incisions into the nose. In an open rhinoplasty, the doctor uses a small cut, called a trans-columellar incision, to cut the middle portion of the nose, between the nostrils. Then, the nasal skin can be folded back temporarily to allow the doctor to see the nasal skeleton. Using this method often requires reconstructing the support structures of the nose in most situations. This approach typically takes three or more hours to perform.

Usually, this method is used when the nose may be especially challenging, and accuracy may be difficult using the closed method. Those with asymmetric, wide nose tips, for example, may need to use the open method. If you have already had nose reconstructive surgery and need cartilage grafting, the open approach may work best for you as well. For most people, however, the open method is not necessary or recommended.

2. The Closed Approach: Endonasal Rhinoplasty

In closed rhinoplasty, all of the incisions occur inside the nose. No part of the cuts can be seen outside the nose, which means that if there is any scarring, it is inside the nose where it is not visible. The structures of the nose are essentially unharmed, and there is usually no need to recreate those vital portions of the nose. This procedure generally lasts around two hours for most patients.

The closed approach works well for those who may have a hump in their nose, but require little to no tip work. However, a skilled surgeon will still be able to do extensive tip work using the closed method as well.

Which Rhinoplasty Method is Right for Me?

Most doctors will prefer one method over the other, and there are pros and cons to each approach. In some situations, the shape and size of the nose may warrant one type of surgery over the other. Some individuals prefer to avoid scarring and use the closed approach if it is an option for them.

Some surgeons will only perform rhinoplasty using the open method because that is what they are used to doing. Closed rhinoplasty can be more difficult for the surgeon, but it has significant benefits over open rhinoplasty for the patient, including:

  • No visible scarring
  • Very little pain
  • Shorter recovery periods
  • Less bruising and swelling after surgery
  • Shorter operating time

The surgeon can also look at the nose right away after surgery to determine if the size and shape are appropriate. If you used the open approach, it could be difficult to tell whether you have made enough (or too many) alterations to have the desired outcome. Being able to evaluate the nose immediately often saves from potentially having to come back for another round of modifications.

Making the Right Choice

Closed rhinoplasty clearly has many advantages over open rhinoplasty, but it does take an extremely skilled surgeon to ensure that the procedure goes as intended. When the procedure is performed incorrectly, it can result in too much stretching of the skin and an unintended alteration of the cartilage.

You should certainly speak to your doctor about which method may be right for you, but finding a skilled surgeon that is willing to do closed rhinoplasty can be difficult. If you live in New Jersey or New York, however, you have better options. Ensure that the doctor has extensive experience and success in closed surgery before you commit to going under the knife.