The open rhinoplasty approach offers unquestioned advantages when operating on the nasal tip. But, what if you just want to reduce a nasal bump? Should it be done closed or open?
The answer, in our opinions, depends on the extent and location of the bump. Some people have a bump that is mostly isolated to the bony part of the bridge. If the bump is mostly bony and in the upper third of your nose, it is perfectly suitable to go through a closed approach. The bony bump can be rasped or shaved down and then osteotomies can be done to narrow or straighten the bones as needed.
For many people, however, the bump is not just in the bony part of the bridge, but is more of a curve that goes all the way from the forehead down to the tip. In these cases, the bump involves the middle portion of the nose which we call the mid-vault. This area, made up of cartilage sidewalls attached to the septum in the middle of your nose, is a vital part of the nasal airway. For this reason, we prefer an open approach when addressing these types of bumps.
The reason we prefer an open approach is that it is critical to re-support these sidewalls to preserve breathing after a bump is taken down in the mid-vault. In a closed approach, the cartilage sidewalls are often reduced along with the bump and the normal connections between the sidewalls and septum are released and left unattached. If left to heal this way, the sidewalls can lose support and fall in or collapse, leading to breathing problems or apparent crookedness, something we call internal valve collapse. The advantage of an open approach is that it provides the access and visibility for the connections between the sidewalls and septum to be more easily and more accurately sutured back together, minimizing chances for poor healing. In a closed approach, reaching this area with a suture from underneath the skin is both less precise and more difficult to accomplish. As a result, some surgeons who prefer a closed approach do not do this, increasing the risk for mid-vault collapse in the long-term. By re-supporting the nasal sidewalls through an open approach, the chances for breathing issues after rhinoplasty can be kept to a minimum.
Whether your nose is operated from an open vs closed technique should honestly not be the dominating question. What is important is that the surgeon you choose has a lot of experience with rhinoplasty and can choose the best approach for your nose in order to optimize your chances for a great result and minimize chances for risks from the procedure.