Open vs Closed
Rhinoplasty

What actually differs

In the closed technique all incisions stay inside the nostrils; there is no external scar. In the open technique a small additional incision is made across the columella, the strip of skin between the nostrils, and the skin is lifted so the structures can be seen directly. The difference is not one of quality but of visibility.

When the open technique is chosen

It is preferred where visibility is critical: in noses that have been operated on before, in marked asymmetry, where cartilage grafting and reconstruction are needed, and where the tip requires complex shaping. In these situations what can be achieved through the closed technique is limited.

When the closed technique is enough

Where the structure is predictable and the intervention limited, the closed technique suffices: removing a bony hump, straightening the dorsum, small refinements at the tip. Because the skin is not lifted, swelling generally settles sooner and there is no external scar.

Scar and healing

In the open technique the columellar incision becomes inconspicuous in most patients within a few months, but it is technically a permanent scar. Swelling lasts somewhat longer with the open approach, particularly at the tip. The closed technique leaves no external scar and early swelling settles faster. With either technique the final result takes about a year.

What decides

The structure of your nose decides, not preference. At examination the bone and cartilage framework, skin thickness, any previous surgery and the extent of the intended change are assessed. Saying "I want the closed technique" does not remove the visibility the operation requires — in that case the surgeon should explain why open access is necessary.

Frequently Asked Questions