Outcomes of Open Versus Closed Rhinoplasty, a Systematic Review and Meta-analysis

Abi Zeid Daou C, Jalkh RM, Semaan ZM, Daou AM.

PubMed 40771258 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 12 studies with 1,067 adults, open and closed rhinoplasty did not differ in satisfaction, breathing scores, swelling, bruising, operating time or complications.

Overview

The choice between an open (external incision) and closed (all inside) approach is a long-standing argument. The Lebanese authors followed PRISMA, searched Medline, PubMed, Embase and Cochrane, and included randomised, prospective and retrospective comparisons in adults. Twenty studies qualified and 12 provided data for meta-analysis on ROE, NOSE, oedema, ecchymosis, complications and operative time.

Sections of note

1,067 patients: 539 open, 528 closed.
ROE (satisfaction): SMD -0.16, not significant; NOSE (breathing): SMD 0.21, not significant.
No differences in oedema, ecchymosis, operative time, satisfaction or complications.
Heterogeneity was very high: I-squared 99% for ROE and 86% for NOSE.
Study quality was moderate, with no sample-size calculations and biased endpoint assessment.

What it means for a patient

On pooled evidence, neither approach gives better results on average; the choice depends on your anatomy and the surgeon's skill.
The columellar scar of open surgery did not translate into lower satisfaction across studies.
The underlying studies vary so much that the pooled estimate is imprecise.

Why this paper matters

It is the current meta-analysis on the most basic decision in rhinoplasty technique. Limits: extreme heterogeneity, moderate study quality, no separation by case complexity.

Terms

Open rhinoplasty: an incision across the columella lets the skin be lifted for direct view.
Closed rhinoplasty: all incisions inside the nostrils.
Standardised mean difference (SMD): an effect size; values near zero mean no difference.
I-squared: the percentage of variation between studies due to real differences rather than chance.
ROE / NOSE: satisfaction and breathing questionnaires.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Despite advancements in techniques, the choice between open and closed rhinoplasty remains contentious. This decision is influenced by patient-specific factors, deformity complexity, and surgeon expertise, with outcomes often tied to functional and aesthetic results.

Methods: A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Medline, PubMed, Embase, and Cochrane. Abstracts and full-text articles were screened, and reference lists from relevant articles were reviewed to identify additional studies. Two investigators independently performed the review. Studies comparing open and closed rhinoplasty techniques, encompassing randomized controlled trials, prospective studies, and retrospective studies, were included. The target population comprised adults (≥18 y) undergoing rhinoplasty. Key parameters analyzed were changes in Rhinoplasty Outcome Evaluation (ROE) score, Nasal Obstruction Symptom Evaluation (NOSE) score, edema, ecchymosis, complications, and operative time.

Results: Twenty studies were included, with 12 providing data for meta-analysis (1067 patients: 539 open rhinoplasty and 528 closed rhinoplasty). Study quality was moderate, with limitations such as the absence of sample size calculations and biased endpoint assessments. No significant differences were identified between the approaches in ROE scores (standardized mean difference = -0.16), NOSE scores (standardized mean difference = 0.21), edema, ecchymosis, operative time, satisfaction, or complication rates. Heterogeneity was observed in the ROE (I² = 99%) and NOSE (I² = 86%) analyses, reflecting technique and patient variability.

Conclusions: Open and closed rhinoplasty techniques show similar efficacy. The choice should be tailored to patient needs and surgeon expertise. Continued innovation and standardized research are essential to optimize outcomes.

Abstract as indexed by PubMed; the article is open access (PubMed Central).