Abstract
Closed or endonasal rhinoplasty has been practiced since the dawn of the modern rhinoplasty era, see Roe’s description in 1887 (Plast Reconstr Surg 45(1):78–83, 1970). In recent years there has been a growing enthusiasm for both teaching and practice of the open approach to rhinoplasty; this technique is both easier to teach and for the student to learn; however, there are small but significant prices to pay for this choice. The most significant is the presence of an external scar on the columella, which proponents of the technique claim to be near invisible but which a significant population of patients find unsightly. Also, despite the clear visibility of both cartilage and bone in the open technique, there is frequent irregularity of contour and of symmetry, especially in inexperienced hands.
The authors prefer the closed technique for its precision, rapid recovery, and lack of external scarring. We also find the technique sympathetic to the frequent frustrations of the less experienced surgeon attempting the technique. For that reason we teach it to our fellows as a “beginner’s” technique until sufficient experience has been gained to graduate to the more technically demanding open procedure.