Closed and Open Rhinoplasty

Rhinoplasty, also known as nose surgery, is one of the most frequently performed procedures in modern plastic surgery, and there are two main approaches in this field: closed and open rhinoplasty.

Each offers its own unique advantages and implementation techniques, providing remarkable results in aesthetic surgery.

What is the Difference Between Closed and Open Rhinoplasty?

In the closed technique, incisions are made inside the nostrils. In the open technique, on the other hand, a small incision is made under the bridge of the nose, which allows the surgeon to have a broader view of the nasal structure. The open technique may be preferred for more complex cases, while the closed technique is suitable for simpler and minor corrections.

If minimal corrections are needed, closed rhinoplasty may be sufficient. For more complex changes, open rhinoplasty is more appropriate. This varies according to personal preferences and needs.

Both techniques are considered safe when applied under suitable conditions by an experienced surgeon.

Revision rhinoplasties, which are surgeries to correct a previously performed nose job, are often considered the most challenging type. Operations aiming to improve both nasal function (such as resolving breathing issues) and aesthetic appearance can be more difficult, as they require balancing the necessities of both aspects. Correcting complex structural deformities that are congenital or result from trauma, as well as performing aesthetic procedures suitable for various ethnic nose structures, are also among the more challenging types.

open vs closed rhinoplasty

What is Open Rhinoplasty?

In open rhinoplasty, the surgeon makes a small incision in the area called the columella, which is between the nostrils. This incision allows for the lifting of the nasal skin, providing direct access to the internal structure of the nose. It enables the surgeon to fully visualize the nose’s internal structure and perform more complex or detailed corrections.

An open rhinoplasty is a suitable option when significant changes in nasal aesthetics are needed or when the patient’s nasal structure requires more detailed intervention.

When performed under appropriate surgical conditions by an experienced plastic surgeon, it is a safe procedure.

Rhinoplasty and Grafts

Open Rhinoplasty with Spreader Grafts

Spreader grafts are small grafts, typically made of cartilage tissue, used to improve airflow inside the nose and support nasal aesthetics. These grafts are placed in the internal parts of the nasal sidewalls and prevent the collapse of the middle portion of the nose, serving both functional and aesthetic purposes.

Open Rhinoplasty with Cartilage Grafts

Cartilage grafts are pieces of cartilage taken from the patient themselves (usually from ear cartilage or rib cartilage) or, less commonly, from a donor. These grafts are used to provide support, shape, or correct the internal structures of the nose in various parts. For instance, cartilage grafts are preferred to straighten the nasal dorsum, support the structure of the nasal tip, or stabilize the nasal sidewalls.

Open Rhinoplasty with Rib Graft

This method aims to reshape and support the nasal structure by using a graft taken from the patient’s own rib cartilage. Rib cartilage grafts are generally preferred in situations where a large amount of cartilage material is needed. For example, they are used to reconstruct the nasal dorsum, support the nasal tip, or replace cartilage tissue lost in previous surgeries.

Open Rhinoplasty Procedure

Open rhinoplasty surgeries typically last between 1.5 and 4 hours. As they are performed under general anesthesia, patients do not feel any pain during the procedure. Postoperative pain and discomfort are generally mild to moderate and can usually be managed with pain relievers for most patients. There may be a slight scar after the surgery, but these scars tend to diminish over time.

Advantages of Open Rhinoplasty

The open method provides an advantage in complex and precise procedures by allowing the surgeon to see the nasal structure in more detail. Additionally, this technique facilitates achieving more symmetric and equal shaping of both sides of the nose.

Disadvantages of Open Rhinoplasty

In open rhinoplasty, there is a risk of scarring due to the incision made. Although this scar typically fades over time, it may not disappear completely. Additionally, since open rhinoplasty involves a more extensive intervention in the nasal structure, there can be more swelling postoperatively.

Who is a Suitable Candidate for Open Rhinoplasty?

  • People with severe nasal curvatures or congenital deformities,
  • People who have had rhinoplasty before and require re-correction,
  • Those who need more detailed aesthetic improvements, such as reshaping the tip of the nose or fine adjustments to the dorsum of the nose,
  • People with functional problems, such as breathing difficulties, 
  • Suitable for noses with thicker skin or people with wide nose tips.

What is Closed Rhinoplasty?

Closed rhinoplasty is a technique where all surgical incisions are made within the nostrils, typically used for simpler aesthetic adjustments. This method is necessary and appropriate for patients who have not undergone any previous nasal surgery and have a structurally uncomplicated nose. It is particularly suited for addressing minor irregularities or slight curvatures on the nasal bridge.

In this technique, stitches are generally not required to be removed, as most of them are of the self-dissolving type. 

There are differences between closed and open rhinoplasty in terms of the surgical process and recovery time. Both techniques are widely used in the field of plastic surgery and are considered safe practices.

Closed Rhinoplasty Procedure

Closed rhinoplasty operations typically last between 1.5 and 3 hours. The first few days post-surgery are generally the most uncomfortable, with potential swelling, bruising, and mild pain in the nose. By the end of the first week, swelling and bruising on the nose and face usually decrease.

If present, nasal splints and tampons are typically removed after a week. By the end of the first month, swelling and bruising tend to disappear. As the surgical incisions in this procedure are made entirely within the nostrils, there are no visible scars left externally.

The surgery is performed under general anesthesia, so no pain is felt during the procedure. Post-surgery, patients usually experience mild to moderate pain, but this is mostly manageable with pain relievers. Some patients might experience a feeling of pressure or blockage in their nose.

Advantages of Closed Rhinoplasty

Closed rhinoplasty has several advantages, including not leaving visible scars, a shorter recovery process, less swelling and bruising, and a shorter duration of the surgical procedure. These benefits make it a favorable option for patients seeking simpler nasal corrections with minimal downtime.

Disadvantages of Closed Rhinoplasty

The disadvantages of closed rhinoplasty include the limited visual field for the surgeon during the operation, increased difficulty in complex cases, especially for revision rhinoplasty, and limited access to certain procedures such as structural changes or cartilage grafting. These constraints can make it challenging to address more intricate nasal structural issues effectively.

Who is a Suitable Candidate for Closed Rhinoplasty?

  • People who want simpler changes or corrections (for example, correction of small protrusions on the dorsum of the nose).
  • People who have not had rhinoplasty before or do not need revision (secondary) rhinoplasty.
  • Those who do not have functional problems such as nasal congestion

What is the Preference for Celebrities?

Celebrities, often faced with demanding work schedules and the pressures of public visibility, might find open rhinoplasty to be a more suitable option. This is because open rhinoplasty can offer shorter recovery times and less noticeable scarring, which are significant considerations for individuals in the public eye.

However, this choice greatly depends on personal needs, the unique structure of the nose, and individual health conditions. The decision between open and closed rhinoplasty should be based on a thorough evaluation of these factors, often guided by the expertise of a skilled plastic surgeon.

It’s important to remember that each case is unique, and the best approach for one individual might not be the same for another, even within the realm of celebrity.

The Cost Difference Between Closed and Open Rhinoplasty

Generally, there is not a significant difference in cost between closed and open rhinoplasty. However, the complexity and duration of the surgery can impact the cost. Open rhinoplasty is suitable for more complex cases, which can lead to higher costs.

In the United States, the cost of rhinoplasty in 2024 varies on average from $5,000 to $15,000. In Mexico, the average cost is between $2,000 and $5,000; in Thailand, it ranges from $2,500 to $5,000; and in India, it is between $1,500 and $4,000.

In private hospitals in Turkey, rhinoplasty costs can range approximately from $3,000 to $5.000.

Dr. Görkem Atsal was born in Amasaya in 1988. He graduated from Hacettepe University Faculty of Medicine in 2012. Specify graduation official (in year): 2012 Yozgat Intercession State Hospital(2012) Hacettepe University Faculty of Medicine Department of Anesthesia (2013) Ege University Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck Surgery (2014) Health Sciences University İzmir Bozyaka Training and Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery (2015-2018) Turkish Otorhinolaryngology and Head and Neck Surgery Association Facial Plastic Surgery School (2020-2021)