Closed Rhinoplasty

A closed or “endonasal” rhinoplasty is nasal reshaping surgery without visible outside scars. Because endonasal rhinoplasties are performed through access incisions in the inside of the nose, it is a procedure that is difficult to teach. Requirements for successful closed rhinoplasty are a thorough understanding of the specific nasal anatomy and an ability to look “through the skin” of the nose to plan changes necessary for the desired improvement.

Closed Rhinoplasty is an Art

Most rhinoplasty surgeons would agree that advanced endonasal rhinoplasty is difficult to learn. In “the old days” of plastic nasal surgery, there were only a handful of accomplished rhinoplasty surgeons. There are many stories about the time when some of these surgeons would not allow anybody to watch what there were doing in the operating room or even put up a drape in order to protect their monopoly of surgical skills. Nonetheless, endonasal rhinoplasty requires surgical expertise and artistic insight.

Is Closed Rhinoplasty Better than the Open Technique?

There is no short yes or no to this question. Both rhinoplasty approaches are currently practiced successfully by nasal surgeons. Both techniques can achieve reliable and pleasing results. And each procedure can result in undesirable outcomes.

Doctors who are more comfortable with open rhinoplasty surgery will point out that he can see better the underlying anatomy and therefore he feels he can deliver better results. He also may tell his patients, that the outside incisions heal very well and are usually not noticeable.

Surgeons who prefer the endonasal technique will explain that they see whatever they have to for a predictable improvement. They may point out that more scaring may result with an open rhinoplasty. And maybe they point out that the closed rhinoplasty approach leaves important support structures in place and therefore it may not require artificial restoration. Most commonly, an endonasal rhinoplasty takes less time to perform. All of these statements are correct but the truth is that these procedures are two different surgeries performed on the nose for one goal: a pleasing nasal appearance. Therefore, it may not be a good idea to ask a open rhinoplasty surgeon to perform a closed procedure and vice versa.

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