I’ve just come back from lecturing on the Milan Rhinoplasty Masterclass.  Interestingly there is still passionate debate about open versus closed Rhinoplasty. I feel it’s important that Rhinoplasty surgeons should be able to form both approaches and therefore offer the patient what they feel is best for their particular nasal problem.  Generally I feel that the open approach is better for more complex cosmetic and functional problems whereas the closed approach is better for smaller changes and refinements where less change is necessary and enjoy performing both.