Open Vs. Closed Rhinoplasty

If you’ve decided to get a nose job to correct imperfections, improve your breathing, or achieve more pleasing facial harmony, you may have already done some preliminary research about the different types of nose jobs. And if so, chances are you’ve come across references to open vs closed rhinoplasty procedures. Both nose job techniques have their advantages and disadvantages, but Dr. Laverson and countless other surgeons prefer the open rhinoplasty. Here’s why: 

What is open rhinoplasty?

Open rhinoplasty refers to a surgical procedure that involves an incision in the columella (the underside of the nose between the nostrils), allowing Dr. Laversom to lift back the skin for optimum visualization of the nasal structures. One of the greatest advantages of this method is that it provides maximum exposure and easy accessibility to the underlying anatomy of the nose. This, in turn, leads to greater accuracy and precision with the intricate surgical techniques required to correct breathing irregularities and achieve the desired contours for a more aesthetically pleasing facial harmony. The open rhinoplasty is typically favored by surgeons because it maximizes cartilage preservation and structural integrity while allowing for more precise modification and shaping.

What is closed rhinoplasty?

During a closed rhinoplasty, the surgeon creates incisions within the nostrils without exposing the full structure of the nose. Although this procedure is less invasive than the open rhinoplasty, has a shorter recovery time, and results in no visible scarring, the narrow surgical openings limit visibility and make the more intricate work of rhinoplasty difficult. There are, however, times when only simple changes are needed to address cosmetic or functional issues, making a closed rhinoplasty the preferred method. 

Why open rhinoplasty is usually preferred

As mentioned above, there are a couple of key differences between the open rhinoplasty and the closed rhinoplasty: visibility and accessibility.  While closed rhinoplasty does offer a shorter recovery time and no scarring, the advantages of open rhinoplasty often outweigh those benefits. While Dr. Laverson certainly can and does perform closed rhinoplasty procedures when appropriate, he prefers the open rhinoplasty, particularly when:

• The patient’s nasal structure has been compromised by a previous nose job
• Several different corrections are needed for best results
• Both functional and cosmetic issues are being addressed
• A more extensive cartilage graft is needed
• Adjustments are needed in the nose tip
• Precise modifications and shaping are desired

When it comes to rhinoplasty, precision is of the utmost importance.  The open rhinoplasty allows Dr. Laverson maximum visibility and easy access to the nasal structures. Under these ideal conditions, greater precision and accuracy are achieved. The closed rhinoplasty limits the changes the surgeon is able to make, and although invisible externally, the incisions involved can compromise the structure of the nose. Simple procedures that do not involve any adjustment to the tip of the nose are sometimes best treated with closed rhinoplasty, but more often, the open rhinoplasty is the best choice for optimizing both aesthetics and function. 

Although most patients express concern over visible scarring with the open rhinoplasty, Dr. Laverson’s surgical techniques and decades of experience result in the tiniest of barely visible scars that typically disappear over time. 

Understanding Rhinoplasty

Rhinoplasty is a surgery that reshapes the nose’s underlying bone, cartilage, and soft tissue to improve its form or function. While often done for cosmetic reasons – for example, smoothing a dorsal hump or refining a bulbous tip – rhinoplasty can also address structural issues that cause breathing difficulties (such as a deviated septum). The ultimate goal is to achieve a nose that looks balanced with your facial features and functions properly, enhancing facial harmony without compromising airflow.

Rhinoplasty may be performed entirely through internal incisions or with a small external cut, but in both cases the surgeon will readjust the bone and cartilage under the skin to create the desired shape. This means that regardless of approach, the same fundamental changes are made to sculpt the nose. 

Why Choose Open or Closed Rhinoplasty?

The terms open and closed rhinoplasty refer to the surgical technique used to access the nasal structures:

• Open Rhinoplasty involves a small external incision across the columella (the tissue between the nostrils), allowing the surgeon to lift the nasal skin and view the entire framework directly.
• Closed Rhinoplasty, also known as endonasal rhinoplasty, uses only internal incisions made within the nostrils, leaving no visible external scars.

The choice between the two approaches depends on several factors, including the complexity of the procedure, the areas of the nose being addressed, and the surgeon’s assessment of which technique will achieve the best outcome.

What Happens During the Procedure?

Whether open or closed, rhinoplasty follows the same general surgical steps. After anesthesia is administered, Dr. Laverson makes the necessary incisions—either internally or both internally and externally, depending on the chosen technique.

Next, he carefully reshapes the bone and cartilage to refine the nasal structure. This may involve removing a hump, adjusting the nasal tip, narrowing the bridge, or correcting asymmetry. In some cases, cartilage grafts are used to provide additional support or improve contour.

Once the structural changes are complete, the skin is repositioned, and the incisions are closed. A splint is typically placed on the outside of the nose to support healing during the first week.

Exploring Open Rhinoplasty

Surgical Method and Access

In an open rhinoplasty, the surgeon makes two incisions inside the nostrils (hidden along the inner rim) plus a small external incision across the columella – the narrow strip of tissue between your nostrils. This external cut, often placed in a staggered “V” or zig-zag line, connects the two internal incisions. By lifting the skin through this opening, the surgeon can “open” up the nose, folding the skin upward and gaining an unobstructed view of the entire nasal framework. 

The open approach essentially turns the nose into a surgical field with full visibility of the nasal bones, cartilage, and septum. After the necessary structural changes are made, the columellar incision is carefully closed with fine sutures. The resulting scar is a small line on the underside of the nose.

Benefits of the Open Approach

• Unparalleled Visibility and Access: The primary benefit of open rhinoplasty is that it gives the surgeon a full, direct view of the nasal anatomy during the operation.
• Greater Precision for Complex Changes: Because of the enhanced visibility and access, the open approach often enables more precise and extensive reshaping of the nose’s framework.
• Facilitates Advanced Grafting and Suturing Techniques: Open rhinoplasty is particularly advantageous when the surgery involves structural grafts or intricate suturing of the cartilage.
• Surgeon Comfort and Comprehensive Approach: Many surgeons find that the open approach simply allows them to execute their techniques with more confidence, since everything is laid out in front of them.

Considerations and Limitations

• Small External Scar: The trade-off for the open technique’s improved access is the visible incision on the columella. The scar from an open rhinoplasty is usually about 4-5 mm in length and is placed on the narrow underside of the nose.
• More Swelling and a Slightly Longer Recovery: Opening the nose and elevating the soft tissue envelope results in a bit more surgical trauma compared to a closed procedure. Consequently, patients who undergo open rhinoplasty tend to experience more swelling in the tip and overall nose in the early postoperative period.

See Rhinoplasty Before and After images of our patients here.

Closed Rhinoplasty

Surgical Method and Access

In a closed rhinoplasty (also called endonasal rhinoplasty), all the surgical incisions are made inside the nostrils, with no external incisions at all. Typically, the surgeon creates small cut(s) just inside each nostril, often along the rim or between cartilage structures, to access the underlying bone and cartilage. Through these internal openings, the nose’s framework is modified – the surgeon works with specialized instruments to remove or reshape bone and cartilage as needed. 

Because the incisions are hidden inside, the nasal skin is not lifted off the structure to the same extent as in open surgery. The surgeon views the anatomy through the nostril openings rather than directly from an external vantage point. Closed rhinoplasty therefore keeps the nasal structure more intact during the operation (the “nose isn’t fully opened up”). 

Once the changes are made, the internal incisions are closed with dissolvable stitches. From the outside, there are no visible cuts or scars with the closed technique.

Benefits of the Closed Approach

• No Visible Scar: One of the biggest draws of the closed approach is that it avoids any external incision, meaning you won’t have a scar on the outside of the nose at all. All cuts are confined to the inside of the nostrils, so there’s no need to worry about a columellar scar.
• Potentially Less Swelling & Faster Early Recovery: Because closed rhinoplasty is somewhat less invasive (the nasal skin isn’t lifted and there’s less dissection of tissues), it tends to cause less trauma and disruption to the nose’s circulation. As a result, patients often experience slightly less swelling and bruising in the initial postoperative period compared to open rhinoplasty.
• Shorter Operative Time (In Some Cases): Closed rhinoplasty can sometimes be a shorter surgery than open, since the surgeon doesn’t have to make and later close the external incision, and there is generally less extensive dissection.
• Ideal for Subtle or Moderate Changes: The closed technique is often well-suited for patients who require only relatively minor adjustments to their nose.
• Less Alteration of Nasal Structure: With a closed approach, since the connective tissues and attachments aren’t fully released (as they are in open rhinoplasty), the natural support structures of the nose are somewhat less disturbed during surgery.

Considerations and Limitations

• Limited Visibility for the Surgeon: The biggest limitation of the closed technique is that the surgeon must work without the same level of direct visibility and access as an open approach.
• Not Ideal for Complex or Major Reshaping: Because of the more restricted access, a closed rhinoplasty can limit the surgeon’s ability to perform extensive structural changes. Highly complex rhinoplasty maneuvers – like major reconstruction of the tip shape, placement of multiple grafts, or correction of severe crookedness – are often much harder to do through internal incisions alone.
• Possibly Higher Revision Rate in Complex Cases: Due to the factors above, patients with complex nasal anatomy who choose a closed surgery might have a slightly higher chance of requiring a touch-up or revision later if something couldn’t be fully corrected initially.
• Surgeon’s Technical Challenge: Closed rhinoplasty can be technically more demanding for the surgeon in some respects. It requires operating instruments at awkward angles and sometimes working “around corners.” There is less tolerance for error because you’re not laying everything open.

In summary, closed rhinoplasty is a wonderful approach for the right candidate – particularly someone seeking refinement without major overhaul, and who prioritizes the absence of an external scar. But for patients requiring significant structural work or those undergoing a secondary rhinoplasty, the closed method may not provide adequate access to achieve the optimal result. Dr. Laverson will assess your nose and let you know if a closed approach is feasible or if an open approach would be more beneficial given your goals.

When to Use Reconstructive vs. Reductive Techniques

Another way to think about rhinoplasty is whether the changes are primarily reductive (taking something away) or reconstructive (adding/supporting structures or making complex corrections). This can sometimes influence whether an open or closed technique is recommended.

• Reductive Rhinoplasty: This refers to procedures where the goal is to reduce or remove certain features of the nose. Classic examples include shaving down a dorsal hump (removing excess bone and cartilage on the bridge) or trimming cartilage to de-project a nasal tip that sticks out too far. Reductive techniques generally make the nose smaller, shorter, or more streamlined.
• Reconstructive (or Structural) Rhinoplasty: Here we’re talking about more complex nose jobs – often ones that involve adding support, rebuilding areas, or correcting significant deformities.

It’s important to note that most rhinoplasties involve a mix of reductive and reconstructive elements. Modern rhinoplasty often employs a “structural” philosophy, meaning even when something is reduced, the surgeon adds support (like a small graft) to maintain long-term shape and breathing. 

Frequently Asked Questions About Open and Closed Rhinoplasty

Will I have a visible scar with open rhinoplasty?

Patients are often relieved to learn that the scar from an open rhinoplasty is minimal and usually hard to detect. The incision is placed on the underside of the nose, across the columella, which is a discreet location. In the first few weeks after surgery, the scar is a thin red line, but with proper care it fades significantly over time. In fact, in most cases the fine columellar scar becomes nearly invisible once fully healed. 

Does skin tone affect how the scar heals?

Generally, skin tone has little influence on the visibility of a columellar scar from rhinoplasty. All skin — whether fair or highly pigmented — tends to heal very well in this area. The scar’s final appearance depends much more on the surgeon’s technique and your individual healing process than on your skin color.

What’s the difference in recovery time?

The initial recovery period is fairly similar for open and closed rhinoplasty, with a couple of small differences. In the first week after surgery, you’ll have swelling, bruising (often around the eyes), congestion, and some discomfort, whether your procedure was open or closed. With a closed rhinoplasty, patients may experience slightly less swelling at the tip of the nose right after surgery and might see their bruising resolve a bit faster.

Which option gives better results?

Neither approach is inherently “better” in terms of final results – what matters most is using the right approach for the right patient and having a skilled surgeon who can execute it well. Both open and closed rhinoplasty, when performed by an expert, can achieve beautiful, natural-looking outcomes. In cases where only minor refinements are needed, a closed rhinoplasty can produce results just as excellent as an open approach. For example, if you only need a small bump removed and slight tip shaping, a closed rhinoplasty (with a qualified surgeon) can yield a fantastic outcome and you’d have no external scar. On the other hand, for more complex cases, an open rhinoplasty often enables a more controlled and precise reshaping, which can translate to a superior result in those situations. 

How to Decide What’s Best for Your Nose

Deciding between an open or closed rhinoplasty is not something you need to figure out on your own. In fact, rather than focusing on the technique upfront, the most important decision you can make is choosing a qualified and experienced rhinoplasty surgeon who understands both approaches inside and out. A seasoned surgeon will examine your nose, listen to your concerns and desired changes, and then determine which approach (open, closed, or sometimes a combination) will achieve the safest and most beautiful result for you.

Schedule a Consultation

If you’re ready to take the next step toward achieving the nose you’ve always wanted, we invite you to contact our San Diego office to set up your rhinoplasty consultation. Under the care of Dr. Laverson – a trusted expert in nasal surgery – you’ll be on the path to a well-informed decision and, ultimately, a beautifully refined nose that complements your face. Your journey to a more confident you starts with that first conversation with Dr. Laverson, where together you’ll chart the course to your ideal nose. We look forward to helping you feel beautiful with results that speak for themselves.

Beautiful nose, beautiful you

At Feel Beautiful, you’re in the hands of one of San Diego’s top plastic surgeons. When you come in for your nose job consultation, Dr. Laverson will evaluate your nasal structure, listen to your concerns, and educate you about your options. He’ll make recommendations based on your nasal and facial anatomy as well as your desired outcomes. Dr. Laverson and the rest of our staff at Feel Beautiful want you to look and feel your best, and we’ll do everything we can to make sure that you do. If you’re ready to enhance your facial harmony with a new nose, or if you need revision rhinoplasty to correct a previous nose job, give us a call at (858) 295-4001 to schedule a rhinoplasty consultation with Dr. Laverson today.