There is not much practical difference between closed and open rhinoplasty approaches; to begin with it must be stated these are not at all kinds of rhinoplasties but ways to access to inner structures of the nose, providing different grades of visualization and technical feasibility of surgical gestures; actually both closed and open approach allow performing exactly the same maneuvers, whatever can be done by closed rhinoplasty can also be done by open one, and vice versa, however not with the same grade of reliability, precision or safety.
Open approach in rhinoplasty is made by means of incisions inside the nostrils, located at lower edge of lateral cruras and narrowly behind the alar rim, and additionally a stepped Rethi or V shaped incision is made at the columella, allowing the lift of the whole tip, alae, dorsum and pyramid skin, the same that is done in closed approach but without the restriction of the columellar skin, providing thus total visualization, access to all areas, maximum precision in diagnosis and technical execution and safer outcomes in high complexity cases.
Open rhinoplasty is best suited for structure rhinoplasties with grafting, advanced tip work, ethnic noses, high complexity cases and revision rhinoplasty.