open vs closed which rhinoplasty technique is best

Open vs. Closed: Which Rhinoplasty Technique Is Best?


One of the most confusing dilemmas in rhinoplasty is deciding on what technique to use to obtain the best results. It is always good for patients to become well-informed about procedure options so that they can make the right decision about their health and appearance. There are two different approaches to reshaping the nasal tip: open rhinoplasty and closed rhinoplasty. Each technique has its own set of advantages and disadvantages that the patient can discuss with Dr. Pearlman before moving forward with their rhinoplasty surgery in New York City.


Open rhinoplasty, also referred to as external rhinoplasty, is performed by making a small incision on the columella, the soft tissue that separates the nostrils. While under general anesthesia or twilight sedation, this technique allows for easy access to the underlying bone and cartilage structure. The primary benefit of the open technique is improved accuracy for reshaping the framework of the nose to achieve desired contouring. The open technique is best used when considering a revision rhinoplasty because the original structure of the nose has already been disturbed. Dr. Pearlman may also use the open technique if the patient’s nose is crooked or to achieve a marked reduction in nasal tip projection (how far the tip sticks out from the face). The open rhinoplasty approach allows for a clearer view of corrections that need to be made as well as clarity and ease for intricate suturing and/or grafting. The scar left behind is barely visible and will usually fade with time.


Closed rhinoplasty, also referred to as endonasal rhinoplasty, is performed by making all necessary incisions completely hidden within the nostrils. Under general anesthesia or twilight sedation, Dr. Pearlman will perform the procedure through separate surgical openings in the left and right nostrils. With no external incisions, the closed technique is less invasive and creates no visible scarring, at all. For many of the changes made during rhinoplasty, the lack of the columellar incision results in slightly less swelling during recovery. Dr. Pearlman can achieve equal results using a closed approach than an open approach. He uses the closed approach in a little over half of his primary rhinoplasties.


The practical difference between the two techniques is small, but the results are important. Without the columellar incision, the closed technique allows for faster operation and less swelling during the recovery period. On the other hand, an open rhinoplasty allows for more precision for difficult noses and when altering the nasal structures for more complex cases. With over 30 years of experience performing thousands of rhinoplasty surgeries, rest assured, Dr. Pearlman is an expert in performing either technique. He will discuss which approach is best for you during your consultation.
For more information on arguably the best rhinoplasty NYC has to offer, or to set up a consultation with board-certified facial plastic surgeon Dr. Steven J. Pearlman, contact our office at 212-223-8300.