Since 1970 when the open, or external, approach to rhinoplasty was introduced to North America, there has been an ongoing discussion (sometimes heated amongst surgeons!) about the better surgical approach. Today, the jury has pretty much made its decision.
In the earliest days of rhinoplasty (the procedure to aesthetically re-shape the nose) the only approach used was closed. This is where incisions are placed inside the nose so they are completely hidden. The rhinoplasty is a very detail-oriented procedure and so many surgeons were looking for a better way to see the specific deformities in a given nose, and to correct them more easily. The concept of making a small incision across the columella (the soft tissue which separates the nostrils) grew in popularity as more and more surgeons tried the technique. Today, several studies have shown that the majority of facial plastic surgeons use the open approach the majority of the time.
So what is the argument? Some would say the closed approach is preferable because there is no external scar, there is less dissection and there is a quicker recovery. Proponents of the open approach feel you can identify anatomical abnormalities better, you can correct them better, and any additional surgical time is due to correcting these problems and ultimately leads to a better result. Many studies have shown the columellar incision is not an issue, with the revision rate of less than 1%.
So… It all depends. If your concern is a “simple” tip or nasal bridge problem, and your surgeon prefers the closed approach because of his or her experience, then this may be the preferred approach for you. If, on the other hand, your aesthetic and anatomical problems are not able to be diagnosed easily, or are more complex, then the open approach may be best for you. Many surgeons today have come to prefer the open approach for most noses, the thinking being, “if the open approach is best for the difficult nose, why is it not also better for the ‘simpler’ nose to get an even better result?” At the end of the day, find a surgeon with whom you feel confident, discuss your preference and different options with him or her, and together make the best decision for you. Remember, there is no “right” or “wrong” approach to rhinoplasty.