Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee WF Jr. Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg. 1996 Jan;122(1):24-34.

The study was small, but very nicely showed that flow through the nasal lymphatics is preserved by careful dissection using either the closed or open approach. The degree of tip swelling regardless of approach has mostly to do with disruption of the muscular fibrous layer of the nasal skin. So, one would expect that a rhinoplasty in which a thick-skinned tip is thinned by trimming some of the fat in this layer would take longer for swelling to go down. Ultimately, it would result in a better outcome, so the swelling is a worthwhile trade off.

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