Open versus closed rhinoplasty: What have we learned?

The "open" (external) and "closed" (endonasal) rhinoplasty approaches remain a subject for debate. Advances in surgical techniques and improved understanding of rhinoplasty dynamics ensure that this topic remains contemporary. The addition of structural support to the nose has been one of the more important realizations of rhinoplasty surgery, with a greater trend for leaving intact, native nasal anatomy and reshaping structure with shaping sutures and grafting techniques. This is in contradistinction to older techniques in which resection and reduction methods were primarily used. The best results from rhinoplasty surgery remain the same over time, whether achieved by these different techniques or whether affected by the selection of the external or endonasal approach. In this article, differences between the two approaches are compared, and a subjective grading of their positive and negative attributes is presented and discussed to help guide and shape modern rhinoplasty concepts.