Rhinoplasty Techniques Explained

All rhinoplasty procedures follow a basic concept. Excess bone and cartilage is removed from the interior nasal structure, and, when needed, a cartilage graft may be added to improve or strengthen the shape of the nose. Once the underlying structure is modified, the outer skin is repositioned over the nose and gradually adheres to the new shape resulting in the “new and improved” nose.

What differs among rhinoplasty procedures is the technique used by the surgeon to gain access to the interior nasal structure. There are two main nose job techniques:

  • Open Rhinoplasty
  • Closed Rhinoplasty

One technique is not necessarily superior to the other. They both allow a surgeon to access the interior nose to make modifications. The biggest factor in whether open or closed rhinoplasty is chosen is the shape of the patient’s nose and the prior experience of the surgeon. Some noses lend themselves to open rhinoplasty while others call for the closed rhinoplasty technique.

What Is Open Rhinoplasty?

Also referred to as an external rhinoplasty, the open rhinoplasty technique connects the incisions which are hidden inside the nostrils to an external skin incision across the columella – the strip of skin located between the nostrils. Once the incision is made, the skin can be lifted away from the nasal structure.

Open rhinoplasty allows a surgeon better access to the interior structures. This is important when major reshaping must be done. It gives the surgeon more latitude to manipulate the nasal shape. Open rhinoplasty is especially helpful in situations where extensive correction is required and in more complex revision rhinoplasty procedures.

What Are The Benefits And Drawbacks Of Open Rhinoplasty?

Benefits of open rhinoplasty include:

  • Easier Surgical Access

For certain procedures, such as revision rhinoplasty, the procedure is more demanding than a simple nose job. With open rhinoplasty, the surgeon has more latitude to examine and manipulate the existing nasal structure, including scar tissue and other impediments that may exist.

  • Allows For More Significant Revisions

Since more of the interior nasal structure is exposed, more dramatic revisions can be achieved.

Drawbacks to open rhinoplasty include:

  • Prolonged Recovery

The incision across the columella interrupts the natural blood flow to and away from the nasal tip skin. It’s as if a dam has been placed at the base of the nose retarding any drainage of swelling. Consequently open rhinoplasty typically requires a longer postoperative course before the final results can be appreciated.

  • Produces an external incision

Since a skin incision is made, sutures will need to be removed postoperatively and the incision site will be visible as a red, or pink line for a few weeks, though they can be covered with concealer and are hardly visible in the short term or thereafter. While the scar is usually quite faint, it will still be noticeable at close range.

Dr. Miller performs many open rhinoplasty procedures at his accredited, NYC surgical suite, conveniently located in his Manhattan office.

What Is Closed Rhinoplasty?

With closed rhinoplasty, the surgeon conducts all nasal reshaping through incisions hidden within the nostrils. While it is a less invasive procedure, it requires more surgeon skill to perform, since the entire operation is conducted with limited visibility and through only a narrow incision inside the nostril.

What Are The Benefits And Drawbacks Of Closed Rhinoplasty?

Benefits of closed rhinoplasty include:

  • No Visible Scarring

Since all incisions are inside the nostril, no external evidence of the nose job can be identified. It also means that a patient does not have to deal with external stitches during the recovery phase.

  • Less Recovery Time

Since the skin bridge between the tip of the nose and the lip remains intact throughout a closed rhinoplasty, the flow of blood and fluid accumulation is unimpaired. Consequently the swelling can drain more easily and patients enjoy a shorter recovery period.

Drawbacks to closed rhinoplasty include:

  • Difficult To Perform

Since all nasal access is through a tiny interior incision, the surgeon must be highly skilled and experienced in limited-visibility surgical procedures.

  • Limits The Ability To Perform All Rhinoplasty Techniques

Closed rhinoplasty is ideal for modifications such as minor tip and bone changes, but procedures which require more complicated and delicate steps may not be able to be performed with the limited access and exposure afforded by the closed technique.

Dr. Miller performs many closed rhinoplasty procedures in NYC every year.

How Do I Know Which Rhinoplasty Technique Is Right For Me?

Every patient is unique and requires a specialized approach to nose job surgery. Whether your surgeon utilizes an open or closed technique will depend on a host of factors, including your existing condition and the nature of the desired changes. Your surgeon will determine the best technique for you during your consultation.

How Do I Learn More About Rhinoplasty Techniques?

If you’d like to find out which technique is right for you, you can set up a consultation with Dr. Miller in his NYC office. Just call us at (646) 791-3112 or complete our convenient Contact Form to get started.

Additional Resources:


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