I know everyone says that the incision on the columella for open rhinoplasty is barely noticeable, but I’d rather not even chance that and just have closed rhinoplasty. Are there any reasons not to have closed rhinoplasty?

The decision to perform an open (also known as external) rhinoplasty or a closed (also known as endonasal) rhinoplasty depends upon a variety of factors.  One factor to consider is your goals for rhinoplasty.  If you wish to address a bump along the bridge of the nose only, then a closed approach would be my preferred approach.  If you wish to achieve tip refinement, then an open approach may afford us the exposure needed to achieve the desired result.  Another factor is your anatomy.  If you would benefit from cartilage grafts to support the nasal anatomy, enhance the nasal airway, and further achieve refinement of the nasal tip, then, the open approach provides us with the exposure needed to place these grafts.