Open vs Closed Rhinoplasty: Which Is Better for You?

Looking for an Open vs Closed Rhinoplasty Guide?

Rhinoplasty, often referred to as a nose reshaping or nose job, is one of the most commonly performed cosmetic procedures worldwide. It can enhance facial harmony, correct asymmetry, or address functional issues such as breathing difficulties.

When planning rhinoplasty, patients are usually presented with two main surgical options, the open or closed approach. Both techniques can deliver excellent results, but they differ in how the surgery is performed, the recovery process, and which type of patient each method is best suited to.

This guide from Real Plastic Surgery explains the key differences between open and closed rhinoplasty, helping you understand what each involves and what might be right for you, so you can have an informed, confident discussion with your consultant.

What Is Rhinoplasty?

Rhinoplasty is a surgical procedure developed to change the shape, size, and function of the nose. It is a highly intricate operation that requires a deep understanding of nasal anatomy, structural support, and facial aesthetics. The nose is comprised of bone, cartilage, and soft tissue, all of which can be modified during the procedure.

The motivation for undergoing rhinoplasty is twofold: aesthetic enhancement and functional correction. Aesthetically, rhinoplasty can address features such as:

• Reducing the size of a nasal hump on the bridge.
• Reshaping a bulbous, drooping, or asymmetrical nasal tip.
• Narrowing the width of the nose or the nostrils.
• Correcting asymmetry following injury or natural development.

Functionally, the surgery often involves correcting a deviated septum or addressing nasal valve collapse, which can significantly improve a patient’s breathing. Regardless of whether the goal is cosmetic, functional, or both, the surgeon’s choice between the open and closed approach determines how they access the nasal framework. This choice is essential because it’s driven by the complexity of the required corrections, your unique nasal anatomy, and your surgeon’s expertise and preferred method. Book your specialist consultation with Mr Naveen Cavale a rhinoplasty surgeon in London leading to explore options that are best for you.

What Is Open Rhinoplasty?

Open rhinoplasty, also known as external rhinoplasty, is the most common approach used for complex nose reshaping, particularly in cases that require extensive structural work. It is defined by a specific incision technique that allows for comprehensive visualisation of the underlying anatomy.

Procedure:

The key feature of open rhinoplasty is the trans-columellar incision, a small, inverted ‘V’ or ‘W’ shaped cut made across the columella (the tissue separating the nostrils). This external incision connects to cuts inside the nostrils. By making this incision, the surgeon can gently lift the nasal skin and soft tissue, providing full, direct exposure of the entire underlying framework of bone and cartilage. This unparalleled view is the primary advantage of the open approach.

Advantages and Application:

The primary benefit of open rhinoplasty is the unparalleled level of visibility and access it grants the surgeon. This direct, complete view allows for exceptional precision. The surgeon can assess anatomical structures and asymmetries in their natural, undistorted state, making it far easier to perform intricate structural modifications.

This approach is highly beneficial when:

• Significant Cartilage Grafting is Required: Open surgery facilitates the accurate placement and secure suturing of cartilage grafts (often taken from the septum, ear, or rib) used to reinforce, support, or augment the nasal structure.
• Major Structural Correction is Required: This is the preferred method for correcting severe septum deviations, addressing nasal collapse, performing complex tip refinements, or revising results from a previous nose job (revision rhinoplasty).

It generally results in a longer operative time and initially causes more swelling and bruising. Furthermore, it leaves a small external scar on the columella, though this scar typically fades to become invisible over several months.

What Is Closed Rhinoplasty?

Closed rhinoplasty, also known as endonasal rhinoplasty, is a less invasive technique where all surgical incisions are kept entirely within the nose. It is often the preferred choice for patients seeking minor adjustments and a quicker recovery with absolutely no visible external scarring.

Procedure:

In the closed approach, all incisions are confined to the inside lining (mucosa) of the nostrils. No incision is made across the columella. The surgeon works through these internal access points, modifying the bone and cartilage underneath the nasal skin without fully lifting or exposing the nasal framework. Specialised instruments are used to carry out the necessary sculpting and reshaping from the inside out.

Advantages and Application:

The main appeal of closed rhinoplasty lies in its minimal invasiveness and swift recovery profile.

• No Visible External Scarring: Since all incisions are hidden inside the nostrils, the procedure leaves no external scar, satisfying patients who prioritise discretion.
• Reduced Post-operative Effects: The procedure involves less dissection and tissue disruption than the open approach. As a result, patients experience less initial inflammation and bruising, and the swelling resolves more quickly, allowing for a faster return to their everyday lives.
• Shorter Operative Time: The closed procedure is generally shorter in duration than its open counterpart.

What are the Differences Between Open and Closed Rhinoplasty?

​Which Rhinoplasty Technique Is Right for You?

Choosing between an open or closed rhinoplasty is an important step in planning your nose surgery. There is no single “best” approach, the success of a rhinoplasty lies not in the incision technique, but in how precisely your surgeon can achieve your desired functional and aesthetic goals.

Your surgeon will recommend the most suitable approach based on several factors:

1. Complexity of your case: Subtle refinements or tip adjustments may be performed using a closed technique, which involves incisions hidden inside the nostrils. More complex reshaping, corrections of asymmetry, or revision surgery often benefit from the open approach, which provides greater visibility and precision.
2. Recovery preferences: The closed approach may offer a slightly quicker initial recovery and avoids an external incision, while the open technique allows your surgeon maximum access for detailed structural work and long-term accuracy.

At Real Plastic Surgery, Mr Naveen Cavale takes a highly individualised approach to rhinoplasty. As a London-based Consultant Plastic Surgeon known for advanced methods such as Piezo Rhinoplasty, he combines technical precision with a deep understanding of nasal anatomy and facial balance, ensuring results that are both natural and long-lasting.

Suggested Guides:

• Septoplasty vs Rhinoplasty Surgery: Key Differences & Which Is Right for You
• Can Rhinoplasty Fix a Deviated Septum? Everything You Need to Know
• Rhinoplasty Surgery Guide

Recovery and Results: What to Expect

Recovery is an important part of planning your rhinoplasty or septorhinoplasty. While the initial healing time can differ between the open and closed approaches, full recovery, when your final nasal definition is visible, takes place gradually over several months. Patience is key, as the most refined results often appear long after the early swelling has resolved.

Immediate Recovery (Weeks 1–2)

The first two weeks mark the most visible stage of healing.

• Splint removal: The external splint or tape is usually removed after around one week. Some swelling will still be present at this stage.
• Swelling and bruising: Patients who undergo a closed rhinoplasty typically experience slightly less initial swelling and can return to daily life sooner. The open technique may involve more visible bruising, particularly around the nasal tip, due to greater tissue exposure.
• Discomfort: Pain is generally mild and well-managed with prescribed medication. Temporary nasal congestion, a blocked sensation, or mild breathing difficulty are common in the first week as internal swelling subsides.

Medium-Term Recovery (Weeks 3–12)

By this stage, most visible swelling and bruising have improved significantly, and the new nasal shape begins to take form.

• Swelling reduction: Around 70–80% of swelling usually resolves within three months, allowing the refined shape to become more visible.
• Tip definition: The nasal tip is the last area to settle and may feel firm or numb during this period. This is more common after open rhinoplasty, where temporary nerve disruption can occur, but sensation gradually returns as healing progresses.

Long-Term Results (6–12+ Months)

Final refinement continues well beyond the early healing phase.

• Final definition: Subtle swelling deep within the tissues can take up to a year or more to fully resolve. As the skin naturally redrapes over the underlying bone and cartilage, the final contour and definition become apparent.
• Scar maturation: For open rhinoplasty, the fine incision across the columella fades gradually, becoming barely visible over time.
• Breathing improvement: For patients who underwent functional correction, such as septoplasty, nasal airflow continues to improve as internal swelling decreases, typically stabilising within six months.