The difference between the “closed” and “open” approaches is structural and philosophical. It is not about an incision. The incision in the columella (the skin and cartilage between the nostrils) should not be an issue of concern. Since the beginning of the popularity of this approach in the early 1980’s, this incision has become a non-issue. This is not an area that most people see. Usually only you, your surgeon, and perhaps your significant other will see the incision. Typically it is not even visible. The real difference between the two approaches is what the surgeon can see during the surgery and the how the cartilages of the nose are modified.
In the classic “closed” (better called “endonasal) rhinoplasty, the view of the cartilages can be a bit limited or skewed to one side. This is fine for some noses, but the surgeon may not be able to see pre-existing irregularities of the tip cartilages and bones that could adversely affect the outcome of the surgery..
In an “open” approach rhinoplasty, there should be no surprises. The surgeon can see everything that needs to be modified. Also, the basic philosophical difference is that in an “open” rhinoplasty the surgeon commonly removes less cartilage and adds structure to the nasal tip that strengthens the underlying architecture and prevents twisting and other adverse changes as you age. Most commonly the surgeon uses your own septal cartilage for these shaping and strengthening cartilage grafts.
In most cases, Dr. Bentkover favors the “open” approach for a primary rhinoplasty. If he needs to make a small modification to an operated nose in a minor revision, he may use a “closed” approach to file the bones down a bit more or perhaps add a small piece of cartilage to fill a small post operative depression. More extensive revision surgery usually requires an open approach.