Outcomes of Open Versus Closed Rhinoplasty, a Systematic Review and Meta-analysis

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.

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.

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.

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.