When it comes to deciding between a closed and open rhinoplasty, how much of that decision is the patient’s vs. the doctor’s?

The decision is a combination of dialogue between patient and doctor.  First, the patient expresses his or her desires for rhinoplasty.  Then, the doctor evaluates the nasal anatomy and determines the best approach to perform the maneuvers needed to achieve the desired result.  Some surgeons may only use the closed, or endonasal approach and some surgeons may only use the open, or external, approach.  I use both approaches and the factors I take into consideration when deciding which approach is most appropriate includes an understanding of the patient’s desired outcome, the patient’s underlying nasal anatomy, and the surgical procedures needed to achieve the desired result.