Nasal surgery. Open or closed access?

Nasal surgery – Which approach is better: open or closed?

The choice between an open or closed approach for rhinoplasty is a key decision for patients considering rhinoplasty. Both approaches offer specific advantages and disadvantages. But which method is right for you? This article explains the differences between open and closed rhinoplasty and helps you to find out which approach might be best for your rhinoplasty.

What is a rhinoplasty?

A nose correction, also known as rhinoplasty, is a surgical procedure to change or correct the shape of the nose. This procedure is performed for aesthetic reasons, e.g. to improve the shape of the nose or to correct irregularities, or for functional reasons, such as to improve breathing. There are two main techniques for performing rhinoplasty: the open and the closed approach.

Open and closed rhinoplasty – what is the difference?

The choice of the right approach for a rhinoplasty depends on various factors. Open rhinoplasty allows the surgeon to expose and directly work on the nasal structures, while the closed technique does not require any external incisions. But what does this mean for the patient? Here is a detailed explanation.

Open rhinoplasty – the approach with precision

In open rhinoplasty, the surgeon makes a small incision on the columella, the area between the two nostrils. This allows the skin above the tip of the nose to be lifted and the underlying nasal structures to be seen and worked on directly.

Advantages of open access:

1. Better visibility and precision: The open technique allows the surgeon to see the nasal structures, i.e. cartilage, bone and tissue, directly and to model them precisely. This is particularly important for complex or secondary nasal operations.
2. Complex changes possible: For difficult procedures or extensive changes, such as reshaping the tip or bridge of the nose, the open approach is often the better choice.
3. Precise symmetry: As the surgeon has direct access to the nasal structures, it is easier to ensure symmetry and accuracy, which is particularly advantageous in aesthetically demanding procedures.

Disadvantages of open access:

1. Visible scar: The open approach leaves a small scar on the bridge of the nose. This usually heals well and is barely visible later, but a minimal external trace of the procedure remains.
2. Longer healing time: Due to the incision and the extensive tissue displacement, the healing time for open rhinoplasty can take a little longer. Swelling may also persist for longer.

Closed rhinoplasty – the scar-free approach

In closed rhinoplasty, the surgeon makes all incisions inside the nose. This technique therefore leaves no external scars and is particularly suitable for minor corrections.

Advantages of closed access:

1. No external scar: As the incisions are only made inside the nose, the skin surface remains intact and the procedure leaves no visible scars.
2. Shorter healing time: As the incisions are less invasive, the healing time can be shorter with the closed technique. Swelling often subsides more quickly, which is pleasant for patients.
3. Suitable for minor corrections: For patients who only require minor adjustments to the tip or bridge of the nose, the closed technique can be an excellent choice.

Disadvantages of closed access:

1. Limited visibility: As the surgeon does not have a direct view of the nasal structure, precision is limited during more complex procedures. This can be a problem with asymmetrical or complicated nose shapes.
2. More difficult in complex cases: The closed approach is not ideal for anatomically demanding corrections or extensive reconstruction of the nose, as direct manipulation of the structures is more difficult.
3. Experience : The surgeon needs many years of experience.

For whom is open or closed access suitable?

The choice between open and closed access depends on the individual requirements and the anatomy of the nose. Here are some examples:

• Open rhinoplasty: Recommended for patients who require a major or complex correction of the shape of the nose, for example in the case of asymmetries, a pronounced nasal hump or extensive reconstructions. The open technique is also often advantageous for secondary rhinoplasty if rhinoplasty has already been performed.
• Closed rhinoplasty: Suitable for patients who only want minor adjustments, such as a slight reduction of the nasal hump or subtle sculpting of the tip of the nose. This technique is also ideal for people who want to avoid visible scars and prefer a shorter healing time.

Healing process and results of open and closed rhinoplasty

Healing after rhinoplasty varies depending on the type of approach and individual healing tendency. In principle, the following applies:

• Open rhinoplasty: The swelling can last a little longer and it often takes several months before the final result is visible. However, the small scar on the bridge of the nose is usually inconspicuous.
• Closed rhinoplasty: The healing time is shorter and the final result is often visible after just a few months. As no external incisions are made, there are no visible scars.

Conclusion – Which approach is better?

Whether the open or closed approach is more suitable for rhinoplasty depends on various factors. The open approach allows for more precision and control, especially in more complex cases, while the closed approach is less invasive and leaves no external scars. However, the decision should be made in close consultation with an experienced specialist who has mastered both the open and closed techniques and can respond individually to the anatomical conditions and wishes of the patient. We personally prefer the closed approach due to our many years of experience and only use the open approach in complex cases. Keywords for rhinoplasty in SEO-optimized form: Nose surgery, nose correction, open rhinoplasty, closed rhinoplasty, nose surgery, nose shapes, scar-free nose correction, healing time nose surgery, rhinoplasty access types, nose surgery advantages and disadvantages, nose correction method.