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Rhinoplasty - Closed or open?


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Hi guys, I'm looking for advices on close and open rhinoplasty.

I understand the gist of it, open is more invasive, requires longer healing time but provide better room of manoeuvre for the doctor and vice versa.

However, I've also read K Couture's bible (I call it that cuz she's knowledgeable af) that open rhino is not really necessary for primary rhino (pardon me if I'm wrong).

Just wondering when is open rhino necessary? Can people who have done either give me some info on this? And how do I determine if I really need an open rhino or if the doctor is only suggesting it because he is more comfortable with using open method.

Does anyone know any clinic that performs close rhino aside from dream? I'm particularly interested in GNG and April 31 as well so any info about them would be great.

Thanks in advance guys!
 
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  • 2 months later...
since i was mentioned in this thread I'm gonna add my 2 cents here. Back when I wrote my original post 2 or 3 years ago, there was one thing I did not understand. And that is the limitations of the closed rhino method. Yes it is possible to get a really nice nose with the closed rhino method. Mine was even considered a reconstructive case as I had extrusion from the previous rhinoplasty. However, like what the other forumers mentioned is partially correct, open rhino will give you a better shape when compared to closed rhino DEPENDNG ON YOUR NOSE STRUCTURE. This is what I did not realize back a few years ago in my original post. I was equating the method to my nose structure, which had thinner tissue due to damage. It was a blessing at the same time because due to this damage, my tissues were thinner and therefore I managed to get a defined shape in the tip. However, If your tissues are thicker and require the bulbous excision procedure to be performed, that is where closed rhino has its limitations. The septal graft extension, the bridge augmentation can be performed with the same degree of results via both methods assuming the surgeon is skilled. However, the bulbous excision procedure has its limitations for the closed rhino method, especially if the patient has thicker skin and fatty tissues around the tip area.
 
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hi dear, I did closed rhinoplasty long ago and regret it, the result the first few months looked amazing. I cannot emphasize how good it looked, but then the tip started to get droopy, so droopy that my nose wasn't even like that before. open rhino gives the surgeon more freedom to shape your nose... watch out when choosing the method, I'd still recommend open rhino.
 
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The tip dropping hasn't got to do with closed or open actually. Its got to do more with your resorption rate. If your nose looked great after closed means the surgery was done well. If it started to drop it means you have a higher resorption rate. Sometimes its also the size of the septal graft or strut thats used. I have a friend that did open rhino 3 times not because the results were bad but because his tip kept dropping after 8 months due to resorption. He finally gave up and accepted the slight imperfection of his nose.

Also, it is common for people to start offwith open rhino, then when the tip drops due to resorption, to get closed rhino to do a touch up and shove a piece of ear cartilage into the tip. Takes 30 mins only. Less invasive
 
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actually that makes sense. I did a revision but there was no chance for the nose tip to drop anymore because they shortened it way too much, but now I have small problems in breathing, it might be deviated ~_~
 
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  • 1 month later...
Thanks for the insight, @K Couture . i take it for primary it's better to do open rhino instead of closed? I have a bulbous nose i guess i have to choose open rhino because of my thick skin..
 
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