Open and Closed Rhinoplasty

Overview

Rhinoplasty can be performed through incisions hidden inside the nostrils, or by adding a small external cut across the columella so the skin can be lifted and the framework seen directly. The authors state that most surgeons use both and recognise that particular situations favour one. The article reviews anatomy, incisions and approaches, then discusses the decision.

Sections of note

• The article is a review chapter, not a study of patients.
• It reviews the anatomy relevant to choosing an approach.
• It sets out the incisions available to the surgeon in each approach.
• It gives general indications for the external approach and for the endonasal approach.
• It discusses the advantages and disadvantages of each.
• No patient numbers, complication rates, satisfaction data or comparative outcomes are reported in the abstract.

What it means for a patient

• Neither approach is universally correct. The choice depends on what the nose needs and on the surgeon's judgement.
• The endonasal approach leaves no visible external scar but gives more limited access to the tip.
• The external approach adds a small scar under the nose and gives direct view of the framework, which matters most for complex tip work and revision surgery.
• This is a narrative review without pooled data, so it cannot say how often either approach produces a better result.

Why this paper matters

The open versus closed question is the oldest running argument in rhinoplasty and still determines how most operations are planned. A review that frames it as a choice per patient rather than a fixed allegiance reflects the mainstream position. What no review of this kind resolves is whether the approaches differ in measured outcomes, since patients are not randomly assigned between them.

Terms

• Open or external rhinoplasty: an approach using a small cut across the columella so the nasal skin can be lifted.
• Closed or endonasal rhinoplasty: an approach using incisions entirely inside the nostrils.
• Columella: the strip of skin and cartilage between the two nostrils.
• Incision: a surgical cut used to gain access.
• Indication: the clinical reason for choosing a particular treatment.