Journal archive · Open versus closed approach · Outcomes, satisfaction and psychology · Anatomy and nasal analysis · 2025
Outcomes of Open Versus Closed Rhinoplasty, a Systematic Review and Meta-analysis
Abi Zeid Daou C, Jalkh RM, Semaan ZM, Daou AM.
What this paper says
Pooling 12 studies with 1,067 adults, open and closed rhinoplasty did not differ in satisfaction, breathing scores, swelling, bruising, operating time or complications.
Overview
The choice between an open (external incision) and closed (all inside) approach is a long-standing argument. The Lebanese authors followed PRISMA, searched Medline, PubMed, Embase and Cochrane, and included randomised, prospective and retrospective comparisons in adults. Twenty studies qualified and 12 provided data for meta-analysis on ROE, NOSE, oedema, ecchymosis, complications and operative time.
Sections of note
- 1,067 patients: 539 open, 528 closed.
- ROE (satisfaction): SMD -0.16, not significant; NOSE (breathing): SMD 0.21, not significant.
- No differences in oedema, ecchymosis, operative time, satisfaction or complications.
- Heterogeneity was very high: I-squared 99% for ROE and 86% for NOSE.
- Study quality was moderate, with no sample-size calculations and biased endpoint assessment.
What it means for a patient
- On pooled evidence, neither approach gives better results on average; the choice depends on your anatomy and the surgeon's skill.
- The columellar scar of open surgery did not translate into lower satisfaction across studies.
- The underlying studies vary so much that the pooled estimate is imprecise.
Why this paper matters
It is the current meta-analysis on the most basic decision in rhinoplasty technique. Limits: extreme heterogeneity, moderate study quality, no separation by case complexity.
Terms
- Open rhinoplasty: an incision across the columella lets the skin be lifted for direct view.
- Closed rhinoplasty: all incisions inside the nostrils.
- Standardised mean difference (SMD): an effect size; values near zero mean no difference.
- I-squared: the percentage of variation between studies due to real differences rather than chance.
- ROE / NOSE: satisfaction and breathing questionnaires.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
Abstract
Background: Despite advancements in techniques, the choice between open and closed rhinoplasty remains contentious. This decision is influenced by patient-specific factors, deformity complexity, and surgeon expertise, with outcomes often tied to functional and aesthetic results.
Methods: A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Medline, PubMed, Embase, and Cochrane. Abstracts and full-text articles were screened, and reference lists from relevant articles were reviewed to identify additional studies. Two investigators independently performed the review. Studies comparing open and closed rhinoplasty techniques, encompassing randomized controlled trials, prospective studies, and retrospective studies, were included. The target population comprised adults (≥18 y) undergoing rhinoplasty. Key parameters analyzed were changes in Rhinoplasty Outcome Evaluation (ROE) score, Nasal Obstruction Symptom Evaluation (NOSE) score, edema, ecchymosis, complications, and operative time.
Results: Twenty studies were included, with 12 providing data for meta-analysis (1067 patients: 539 open rhinoplasty and 528 closed rhinoplasty). Study quality was moderate, with limitations such as the absence of sample size calculations and biased endpoint assessments. No significant differences were identified between the approaches in ROE scores (standardized mean difference = -0.16), NOSE scores (standardized mean difference = 0.21), edema, ecchymosis, operative time, satisfaction, or complication rates. Heterogeneity was observed in the ROE (I² = 99%) and NOSE (I² = 86%) analyses, reflecting technique and patient variability.
Conclusions: Open and closed rhinoplasty techniques show similar efficacy. The choice should be tailored to patient needs and surgeon expertise. Continued innovation and standardized research are essential to optimize outcomes.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
Start here
What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Open versus closed approach
Whether the surgeon opens the nose through a small incision across the columella or works entirely through the nostrils has been argued in print since 1973, was put on facing pages of Plastic and Reconstructive Surgery by Jack Gunter and Jack Sheen in 1997, and was finally pooled in 2025: across twenty studies and 1,067 patients there is no significant difference in what patients report, in breathing, in complications or in swelling.
Outcomes, satisfaction and psychology
Rhinoplasty is measured with ten different questionnaires, none of which covers both the way the nose looks and the way it breathes, and the best-developed one has no airway questions at all.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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