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Dr. Toby’s Chat Room | Rhinoplasty – Open or Closed Technique

Dr. Toby Mayer

Dr. Toby Mayer, M.D., F.A.C.S.

I am frequently asked what is the difference between an open vs. closed rhinoplasty. When I was in training, all noses were done closed, meaning all of the incisions were made inside the nose. I did my first open rhinoplasty in 1975. The only difference was, I connected the internal incisions to an external incision between the nostrils. This allowed me to “lift up the hood” and see exactly what the problems were that I needed to change to get the desired nose. (In those days I was a “heretic” and today I am a pioneer.) There were only 2 other surgeons besides myself and my partner, Dr. Richard Fleming doing open noses in the US.

The advantages of the open is that it allows excellent access and the ability to suture grafts, etc in place. The disadvantage most often cited in those days was the scar–which is the easiest part of the rhinoplasty, and I have never had to revise one. Its only real disadvantage is that it takes a little longer for the swelling in the tip to go down.

The closed nose has less swelling, but is not as good in some noses for correct diagnosis of the problem. There are many good surgeons who do primarily closed rhinoplasty and many who do primarily open rhinoplasty. About 50 percent of my rhinoplasty surgery is revisions from other surgeons, and I do most open and some closed, depending on what the problem is. Choose your surgeon based on results and experience, not technique!