Plastic Surgery 101

Which method should be used for your nose job?

Q. I’m very interested in having a rhinoplasty. I have seen several doctors and have had several different opinions. One doctor insists that I do an open rhinoplasty and another doctor says that I don’t need it. What do you think?

A. It is difficult for me to tell you which technique of rhinoplasty for you to have without seeing you. The technique of open rhinoplasty is one where an incision is made underneath the columella (middle partition) and the skin is elevated over the rest of the nose.

The close technique is one where all the incisions are made inside the nose and you spare the elevation of all the skin over the tip of the nose. Each technique has its advantages and disadvantages.

The open rhinoplasty technique is used for patients with difficult tips, asymmetric tips that are wide and need significant improvement. This technique is also used for patients who have had previous surgery and require cartilage grafting to improve symmetry. Some surgeons only use this technique because of their comfort level, but if a patient does not require much tip work, I would not recommend it.

The closed rhinoplasty technique is one that spares many of the crucial attachments and support structures of the tip. The support structures then have to be re-created and sutured back together during the open rhinoplasty procedure. This technique is primarily for someone who has a hump but requires minimal tip work. With a skilled surgeon you can do a lot of tip work and grafting through the same technique.

This technique is hard to learn and has been lost over the years as most new rhinoplasty surgeons are using the open technique exclusively. When choosing a surgeon for your nose surgery, discuss with them your aspirations, look at patients’ before and after photos photos and discuss with your doctor the benefits and risks of the surgery.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at