Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 569-579
DOI: 10.1055/s-0042-1756315
Cosmetic: Review Article

Outcomes of Closed versus Open Rhinoplasty: A Systematic Review

Rohun Gupta 
1   Oakland University William Beaumont School of Medicine, Rochester, Michigan
,
Jithin John
1   Oakland University William Beaumont School of Medicine, Rochester, Michigan
,
Noopur Ranganathan
1   Oakland University William Beaumont School of Medicine, Rochester, Michigan
,
Rima Stepanian
1   Oakland University William Beaumont School of Medicine, Rochester, Michigan
,
Monik Gupta
2   The University of Toledo Health Science Campus, Toledo, Ohio
,
Justin Hart
3   Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
,
Farideddin Nossoni
3   Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
,
Kenneth Shaheen
3   Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
,
Adam Folbe
4   Department of Otolaryngology, Beaumont Health Systems, Royal Oak, Michigan
,
Kongkrit Chaiyasate 
3   Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case–control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.

Keywords

rhinoplasty - cosmetic techniques - reconstructive surgical procedures - nasal surgical procedures

Disclosure

The authors have no financial interests in relation to the content of the article.


Ethical Approval

Institutional review board approval as well as patient consent were not required for this study.


Authors' Contributions

Conceptualization: R.G., J.J., N.R., R.S., M.G., J.H., F.N., K.S., A.F., K.C. Funding acquisition: None required. Methodology: R.G., J.J. Writing original draft: R.G., J.J., N.R., R.S., M.G., J.H., F.N., K.S., A.F., K.C. Writing - review & editing: R.G., J.J., K.S., A.F., K.C.




Publication History

Received: 01 January 2022

Accepted: 18 April 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gowen L, Mawr B. Two types of rhinoplasty explained – cosmetic vs functional. July 23, 2019. Accessed November 25, 2021, at: https://www.plasticsurgery.org/news/blog/two-types-of-rhinoplasty-explained-cosmetic-vs-functional
    Google Scholar
  • 2 O'Hara J, Ruggiero F, Wilson L. et al. Syndromic craniosynostosis: complexities of clinical care. Mol Syndromol 2019; 10 (1-2): 83-97
    CrossrefPubMedGoogle Scholar
  • 3 2020 Plastic Surgery Statistics. Updated April 21, 2021. Accessed November 25, 2021, at: https://www.plasticsurgery.org/news/plastic-surgery-statistics
    Google Scholar
  • 4 Tasman AJ. Rhinoplasty - indications and techniques. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc09
    PubMedGoogle Scholar
  • 5 Rohrich RJ, Afrooz PN. Primary open rhinoplasty. Plast Reconstr Surg 2019; 144 (01) 102e-117e
    Google Scholar
  • 6 Momeni A, Gruber RP. Primary open rhinoplasty. Aesthet Surg J 2016; 36 (09) 983-992
    CrossrefPubMedGoogle Scholar
  • 7 Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 2004; 114 (05) 1298-1308 , discussion 1309–1312
    CrossrefPubMedGoogle Scholar
  • 8 Gunter JP, Rohrich RJ. External approach for secondary rhinoplasty. Plast Reconstr Surg 1987; 80 (02) 161-174
    CrossrefPubMedGoogle Scholar
  • 9 Jayarajan R, Natarajan A, Nagamuttu R. Outcomes of closed versus open technique of rhinoplasty during primary repair of unilateral cleft lip: a systematic review. Cleft Palate Craniofac J 2019; 56 (01) 74-83
    CrossrefPubMedGoogle Scholar
  • 10 Fichman M, Piedra Buena IT. Rhinoplasty. In: StatPearls. Treasure Island, FL: StatPearls Publishing; June 29, 2021
    Google Scholar
  • 11 Tebbetts JB. Open and closed rhinoplasty (minus the “versus”): analyzing processes. Aesthet Surg J 2006; 26 (04) 456-459
    CrossrefPubMedGoogle Scholar
  • 12 Schreiber JE, Marcus E, Tepper O, Layke J. Discovering the true resolution of postoperative swelling after rhinoplasty using 3-dimensional photographic assessment. Plast Reconstr Surg Glob Open 2019; 7 (08) 11-12
    Google Scholar
  • 13 Shemshadi H, Azimian M, Onsori MA, Azizabadi Farahani M. Olfactory function following open rhinoplasty: a 6-month follow-up study. BMC Ear Nose Throat Disord 2008; 8: 6
    CrossrefPubMedGoogle Scholar
  • 14 Dengiz R, Haytoğlu S, Görgülü O, Doğru M, Arıkan OK. Effect of septorhinoplasty on olfactory function: assessment using the brief smell identification test. Turk Arch Otorhinolaryngol 2015; 53 (01) 4-9
    CrossrefPubMedGoogle Scholar
  • 15 Toriumi DM, Kowalczyk DM, Cristel RT. et al. Evaluation of postoperative infection rates in 3084 rhinoplasty cases using antibiotic soaks and/or irrigations. Facial Plast Surg Aesthet Med 2021; 23 (05) 368-374
    Google Scholar
  • 16 Rettinger G. Risks and complications in rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc08
    PubMedGoogle Scholar
  • 17 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
    Google Scholar
  • 18 Motamed S, Otaghvar HA, Niazi F, Moosavizadeh SM, Motaghedi B, Tizmaghz A. Introducing a favourite tip definition and projection with tripod suture in rhinoplasty. J Clin Diagn Res 2017; 11 (01) PC05-PC07
    PubMedGoogle Scholar
  • 19 Jaberoo MC, De Zoysa N, Mehta N. et al. A twin-center study of nasal tip numbness following septorhinoplasty or rhinoplasty. Ear Nose Throat J 2016; 95 (02) E18-E21
    CrossrefPubMedGoogle Scholar
  • 20 Paul MA, Kamali P, Chen AD. et al. Assessment of functional rhinoplasty with spreader grafting using acoustic rhinomanometry and validated outcome measurements. Plast Reconstr Surg Glob Open 2018; 6 (03) e1615
    CrossrefPubMedGoogle Scholar
  • 21 Han SK, Woo HS, Kim WK. Extended incision in open-approach rhinoplasty for Asians. Plast Reconstr Surg 2002; 109 (06) 2087-2096
    CrossrefPubMedGoogle Scholar
  • 22 Ozmen S, Ayhan S, Findikcioglu K, Kandal S, Atabay K. Upper lateral cartilage fold-in flap: a combined spreader and/or splay graft effect without cartilage grafts. Ann Plast Surg 2008; 61 (05) 527-532
    CrossrefPubMedGoogle Scholar
  • 23 Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg 2002; 109 (03) 1128-1146 , quiz 1145–1146
    CrossrefPubMedGoogle Scholar
  • 24 Sevin A, Sevin K, Erdogan B, Deren O, Adanali G. Open rhinoplasty without transcolumellar incision. Ann Plast Surg 2006; 57 (03) 252-254
    CrossrefPubMedGoogle Scholar
  • 25 Guerrerosantos J. Open rhinoplasty without skin-columella incision. Plast Reconstr Surg 1990; 85 (06) 955-960
    CrossrefPubMedGoogle Scholar
  • 26 Won Kim S, Pio Hong J, Kee Min W, Wan Seo D, Kyu Chung Y. Accurate, firm stabilization using external pins: a proposal for closed reduction of unfavorable nasal bone fractures and their simple classification. Plast Reconstr Surg 2002; 110 (05) 1240-1246 , discussion 1247–1248
    CrossrefPubMedGoogle Scholar
  • 27 Cárdenas-Camarena L, Guerrero MT. Improving nasal tip projection and definition using interdomal sutures and open approach without transcolumellar incision. Aesthetic Plast Surg 2002; 26 (03) 161-166
    CrossrefPubMedGoogle Scholar
  • 28 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (06) 1903-1910
    CrossrefPubMedGoogle Scholar
  • 29 Kiliç C, Tuncel Ü, Cömert E, Şencan Z. Effect of the rhinoplasty technique and lateral osteotomy on periorbital edema and ecchymosis. J Craniofac Surg 2015; 26 (05) e430-e433
    CrossrefPubMedGoogle Scholar
  • 30 Kim HS, Suh HW, Ha KY, Kim BY, Kim TY. The usefulness of the endonasal incisional approach for the treatment of nasal bone fracture. Arch Plast Surg 2012; 39 (03) 209-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Metin M, Avcu M. The effect on patient satisfaction of the postoperative nasal topographic, demographic, and functional results of open and closed septorhinoplasty techniques. J Craniofac Surg 2021; 32 (03) 868-873
    CrossrefPubMedGoogle Scholar
  • 32 Reilly MJ, Davison SP. Open vs closed approach to the nasal pyramid for fracture reduction. Arch Facial Plast Surg 2007; 9 (02) 82-86
    Google Scholar
  • 33 Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope 2012; 122 (02) 254-259
    CrossrefPubMedGoogle Scholar
  • 34 Talmadge J, High R, Heckman WW. Comparative outcomes in functional rhinoplasty with open vs endonasal spreader graft placement. Ann Plast Surg 2018; 80 (05) 468-471
    CrossrefPubMedGoogle Scholar
  • 35 Uppal R, Yousif AH, Maheshwari K. Outcome-based comparative study to examine the correction of columella deformities following rhinoplasty. Plast Reconstr Surg Glob Open 2020; 8 (07) e3001
    CrossrefPubMedGoogle Scholar
  • 36 Okur Mİ, Gökdemir O, Karasu N, Yildirim AM. Comparison of nasal senses following open and closed rhinoplasty. Turk J Med Sci 2016; 46 (02) 287-290
    CrossrefPubMedGoogle Scholar
  • 37 Yoon T, Kim Y. Postoperative satisfaction in nasal bone fracture patients who had rhinoplasty. J Craniofac Surg 2016; 27 (07) 1707-1710
    CrossrefPubMedGoogle Scholar
  • 38 Gökçe Kütük S, Arıkan OK. Evaluation of the effects of open and closed rhinoplasty on the psychosocial stress level and quality of life of rhinoplasty patients. J Plast Reconstr Aesthet Surg 2019; 72 (08) 1347-1354
    CrossrefPubMedGoogle Scholar
  • 39 Kirgezen T, Yigit O, Taskin U, Cakir ZA, Adatepe T. Electromyographic and electroneurographic changes in internal nasal muscles after endonasal and external rhinoplasty. Aesthet Surg J 2011; 31 (03) 297-301
    CrossrefPubMedGoogle Scholar