Plastic Surgery 101

Deciding on whether to have an open or closed nose job

Q.I’m thinking of having a rhinoplasty. I have gone to a few doctors and have heard different opinions. Some tell me that the only way to do my nose is with an open rhinoplasty approach, while others tell me I can do it open or closed. What is your opinion of which way I should do my rhinoplasty?

A. Rhinoplasty, or cosmetic surgery of the nose, is a very complicated procedure. There are two approaches that can be taken.

The close approach is surgery that is done through the nose (endo-nasal). The open approach is done by making an incision in the columella (the area that separates the nostrils) and elevating the entire skin over the nasal cartilages and bone. The open approach disrupts many of the stabilizing factors of the tip of the nose, which then have to be reconstructed, grafted or improved. It is not wrong to choose either one of the approaches as long as the surgeon who is performing the surgery is comfortable doing it. What I do feel is wrong is making every patient have an open rhinoplasty if they don’t need one.

Open rhinoplasty was designed primarily to perform surgery for patients who have wide tips, tips that need grafting because of previous bad surgery or need reconstructive surgery for their tips. Because of the complexity of rhinoplasty surgery, the open approach has become routine for physicians who find it easier (for them) to perform surgery.

On patients who have a bump along with a very nice nasal tip that needs minimal change, I would perform a closed rhinoplasty procedure. If your nose has a wide nasal tip, is overprojected (sticking out far from your face) or you had a previous rhinoplasty and need it to be fixed, I would perform an open rhinoplasty procedure. Not all noses are created equal, or look equal or need equal treatment.

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