The Closed (Scarless) Approach to Rhinoplasty

Many people familiar with plastic surgery understand that rhinoplasty is the name of the procedure designed to reshape the nose, and that it can be performed for cosmetic reasons or to improve nasal breathing. However, it can be difficult to understand terminology related to the surgical approaches and techniques of rhinoplasty. In general, there are two main surgical approaches to rhinoplasty, the open approach and the closed approach.

The Open Rhinoplasty Approach

The open approach involves making an external cut across the skin at the base of the nose. After this cut is made, the skin is lifted off of the underlying cartilage and bone, and the nose can then be reshaped. The advantage of this approach is that the surgeon has excellent visibility of the nasal structures during surgery. However there are several disadvantages of this approach. The most obvious disadvantage is that the patient is left with a scar at the base of their nose. Additionally, postoperative nasal swelling can last many months after rhinoplasty using this approach. And lastly, because so much of the nasal tissues are manipulated during surgery, postoperative healing can be unpredictable, leading to a final result that looks much different than the initial postoperative result. Despite these drawbacks, the open approach is occasionally required for certain rhinoplasty maneuvers or major nasal reconstructions.

The Closed Rhinoplasty Approach

The closed approach, or “scarless approach”, involves making all of the surgical cuts inside the nose, and this approach can be utilized to perform the overwhelming majority of rhinoplasty maneuvers. The disadvantage of this approach is limited visibility of the surgeon during surgery, although this is not often a significant barrier for the experienced surgeon. The most obvious advantage of this approach is that the patient has no visible scars afterward. Additionally there is less manipulation of the tissues with this approach. This results in less postoperative pain and swelling. It also leads to more predictable healing, which means that the final result often looks very similar to the initial postoperative result. Generally speaking, the closed approach is also much faster than the open approach, and patients tend to have better outcomes when they spend less time in the operating room.

One common misconception about the closed approach is that it cannot be used to perform a tip rhinoplasty. Not only can the nasal tip be accessed through this approach, but also because there is less disruption of the nasal support structures, the surgical result can be longer lasting when compared to the open approach. Another misconception is that the closed approach cannot be used in revision rhinoplasty. On the contrary, the closed approach can be ideal in revision rhinoplasty, especially in patients with heavy scarring, as less tissue manipulation is required. Even in cases where an extra source of cartilage is required, such as ear or rib cartilage, the closed approach can be ideal to create tight pockets, which prevent unwanted movement of the cartilage grafts. For these reasons, the closed approach is our favored method, and patients are overwhelmingly thrilled with their results.