Rhinoplasty – open or closed technique?

The nose is the center of the face. Even small changes can make a significant difference – but only if the surgeon can truly see what they are doing. In this article, I will explain honestly and in simple terms what lies behind the two surgical techniques of rhinoplasty and why, after many years of experience, I almost always prefer the open approach.

First: what is rhinoplasty?

Rhinoplasty – commonly referred to as a “nose job” – is one of the most complex and at the same time most impactful procedures in aesthetic surgery. The nose shapes the face like almost no other feature: it sits at the geometric center, influences the proportions of the forehead, cheeks, and chin, and plays a key role in how balanced a face appears. Even small changes can significantly enhance overall harmony – or, if poorly planned, disrupt it.

During rhinoplasty, the shape, size, or function of the nose is surgically modified. The range of possible corrections is broad:

• removing a hump on the nasal bridge
• lifting, refining, or rotating the nasal tip
• straightening a crooked nose
• adjusting nostrils that are too large or too small
• improving breathing issues (e.g. correcting a deviated septum)

There are two fundamental approaches a surgeon can use to access the nose: the closed technique and the open technique. While the difference may sound technical, it has a major impact on what the surgeon can see, plan, and ultimately achieve.

The closed technique in rhinoplasty: what’s behind it?

With the closed technique, the surgeon places all incisions inside the nostrils. From the outside, no visible scars remain – which many people initially find very appealing.

However, the surgeon operates without direct visibility. The skin is lifted and the procedure is performed through the narrow nasal openings, without ever having a full view of the entire nasal framework.

Advantages:

• no visible external scar
• slightly shorter operation time
• faster reduction of swelling during the first weeks

Disadvantages:

• limited visibility for the surgeon
• less precision in complex corrections
• more difficult to plan

Who is the closed (endonasal) method suitable for in rhinoplasty?

The closed technique can be suitable for very simple, clearly defined corrections – for example, a small dorsal hump reduction where the nasal tip does not need to be adjusted.

However, in my practice, such cases are rather the exception.

The open approach in rhinoplasty: a direct view of the truth

In open rhinoplasty, an additional small incision is made across the narrow strip of skin between the nostrils – the so-called columella. This incision is tiny, usually less than one centimeter long, and is placed so discreetly that it becomes practically invisible to others once healing is complete.

Through this small incision, the entire nasal skin can be gently lifted like a small tent. This allows the surgeon to see the full nasal framework – cartilage, bone, and soft tissue – in complete clarity and from all angles at once.

Imagine you want to repair a complex clockwork mechanism. With the closed technique, you would have to work through a small side opening by feel. With the open technique, you can remove the cover and view the entire mechanism from above. Which approach allows for greater precision and control?

Why I almost always choose the open technique for rhinoplasty

After many years of experience in nasal surgery, I have developed a clear conviction: the open technique simply provides me, as a surgeon, with the better foundation – and this directly benefits my patients.

Reason 1: I can see what I am doing

This may sound obvious – but it is not. With the closed technique, I work largely by feel and must carefully navigate my way step by step. With the open approach, I can see every cartilage structure, every asymmetry, and every individual characteristic of the nose in full detail. What I can clearly see, I can also correct with greater precision.

Reason 2: I can compare both sides simultaneously

Most noses are naturally slightly asymmetrical – one side may differ subtly from the other. With the open technique, I can immediately recognize these differences and adjust both sides in direct comparison. With the closed technique, this level of precise symmetry correction is very difficult to achieve.

Reason 3: The nasal tip can be shaped much more precisely

The nasal tip is the most complex part of the entire nose. It consists of two curved cartilages that need to be carefully shaped, weakened, supported, or repositioned depending on the desired outcome. This is only possible when the structures are clearly visible. Especially in nasal tip refinement, the open technique is clearly superior to the closed approach.

Reason 4: Cartilage grafting is significantly more precise

In some cases, the nose requires additional structural support – for example when lifting the nasal tip or reconstructing a collapsed nasal bridge. For this, I use the patient’s own cartilage, often taken from the nasal septum. Placing and securely fixing this cartilage in the correct position is considerably easier and more reliable with the open technique.

Reason 5: Fewer surprises, more control

Every nose is different. What looks well planned on photos can appear quite different once viewed from the inside during surgery. With the open technique, I can respond flexibly during the procedure – I see everything in real time and can adapt my surgical plan accordingly. This significantly reduces the risk of revision surgery later on.

My conviction as a surgeon:
The tiny scar on the columella, which becomes barely visible after a few months, is a very fair price for a much more precise, better planned, and more predictable long-term result. I have never met a patient who was bothered by this small detail.

Are scars visible after rhinoplasty?

This is the question I am asked most often. The honest answer is: in the first few weeks, the small scar on the columella is visible. It appears pink and slightly raised – this is completely normal and part of the healing process.

After about three to six months, it becomes barely noticeable for most people. After one year, it is usually so faint and fine that even on close inspection it is hardly visible – unless you know exactly where to look.

To put this into perspective: the scar is located on the underside of the nose – precisely in an area that is rarely seen during normal conversation or in photographs. On selfies, front-facing photos, or side views, it is not visible at all.

The course of a rhinoplasty – what happens and when?

Phase	What happens?
Before surgery	• detailed consultation • digital imaging/planning • blood tests • discussion of wishes and realistic expectations
Day of surgery	• procedure performed under general anaesthesia (2–3 hours) • short post-operative stay; in most cases, returning home the same day is possible
Week 1–2	• nasal splint and tape protect the new shape • swelling and mild bruising around the eyes are normal
Week 2	• splint is removed – first glimpse of the preliminary result
Months 1–6	• swelling gradually decreases • the nose slowly refines and settles into its final shape
Month 6–12	• final result becomes fully visible • scar fades significantly

Is rhinoplasty painful – and how long will I need to stay at home?

You won’t feel the operation itself, as you are in a deep, comfortable sleep under general anaesthesia. Afterwards, the nose is swollen and feels blocked, which can be slightly uncomfortable at first. However, most patients do not describe this as real pain – rather as a feeling of pressure or tightness.

You should plan to rest and stay at home for the first two weeks. After that, many patients are able to return to work – depending on their profession. Physically demanding activities and sports should be avoided for about six to eight weeks.

Important: In the first weeks, the nose must not be exposed to any impact. This means no intensive sports, no pressure on the nasal bridge from glasses (an alternative is to tape the glasses to the forehead or cheeks), and no sunbathing without protection.

Curious to learn more? Book a consultation.

Bring your questions – and if you like, also photos of noses you find appealing. During the initial consultation, we will carefully assess your nose together, discuss your wishes honestly, and use digital imaging to show what is realistically possible.

The consultation is free of charge and without obligation.