Jolie,
You can achieve natural results with either an endonasal or an open approach to rhinoplasty. The different approaches both work, but each should be used in the appropriate circumstances for that patient and according to the surgeon’s preference. There are surgeons who perform almost all of their procedures one way or the other. I prefer to use the endonasal approach in simple noses that require only a hump reduction with perhaps a little tip narrowing and in a nose that could also be made a little smaller, deprojected, and/or rotated a little. If a nose has significant asymmetry, needs more tip work, or needs to be projected or de-rotated then I prefer the open approach. I am also very careful to not over narrow the middle part of the nose which can happen in an endonasal rhinoplasty. If my patients have any narrowness to their nose pre-operatively and need a hump taken down, the narrowness will likely get worse and so I place what is known as spreader grafts. This will not only lead to a more natural result, but will also prevent functional and cosmetic problems years down the road.
Sorry for the long answer, but rhinoplasty is a very complicated operation and requires a little more thought than just a yes or no answer. Good luck with your decision.
Ed Buckingham
