Open vs Closed Rhinoplasty: How Modern Techniques Have Evolved

By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney & Brisbane

Rhinoplasty techniques have evolved significantly over the past few decades. While two primary surgical approaches exist—open and closed rhinoplasty—modern practice has increasingly shifted toward open structured rhinoplasty for its superior predictability, long-term stability, and capacity to address both aesthetic and functional concerns comprehensively.

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney and Brisbane, performing both cosmetic and functional nose surgery. In this article, he explains the key differences between these techniques and why contemporary rhinoplasty has moved toward structural approaches that prioritise lasting results.

What Does Rhinoplasty Address?

Rhinoplasty refers to surgical modification of the nose, encompassing procedures that alter the nasal bones, cartilage, and soft tissues. Patients may seek rhinoplasty for aesthetic concerns, breathing problems, or both.

Common concerns addressed by rhinoplasty include:

• Irregularities along the nasal bridge
• Tip shape, projection, or position
• Nostril size or asymmetry
• Width of the nasal base
• Breathing obstruction due to septal deviation or valve collapse

The structural complexity of each patient’s nose varies considerably, and this anatomy plays a significant role in determining which surgical approach will deliver the most reliable long-term outcomes.

The Evolution Toward Open-Structured Rhinoplasty

Rhinoplasty has undergone a fundamental shift in philosophy over the past several decades. Traditional approaches often relied heavily on tissue removal—reducing cartilage and bone to achieve desired contours. However, surgeons observed that excessive tissue removal frequently led to problems that emerged years after surgery, including airway compromise, tip drooping, visible irregularities, and structural collapse.

This recognition prompted the development of structured rhinoplasty, which prioritises augmentation and reinforcement over tissue removal. Rather than simply resecting cartilage, the structural approach reconstructs the nasal framework using cartilage grafts to provide essential support and resist the deforming forces of scar contraction and ageing.

Open rhinoplasty has become the preferred technique for structural work because it provides direct visualisation, allowing grafts to be placed precisely and creating a stable nasal framework that maintains results over the patient’s lifetime.

Modern advances, such as ultrasonic rhinoplasty, have further enhanced the precision of open techniques, enabling more controlled bone modification with reduced tissue trauma.

Understanding the Two Approaches

What Is Open Rhinoplasty?

Open rhinoplasty involves an external incision placed across the columella—the narrow strip of tissue separating the nostrils. This incision connects to internal incisions within each nostril. Once made, the nasal skin is elevated, providing direct visualisation of the underlying cartilage and bone framework.

This approach allows the surgeon to work with the nasal structures under direct vision, enabling precise modifications and accurate placement of structural grafts. The technique is essential for cases requiring substantial structural modification, cartilage grafting, tip refinement, or functional correction.

What Is Closed Rhinoplasty?

In closed rhinoplasty, all incisions are confined within the nostrils. There is no external incision on the columella. The surgeon works through these internal access points, making adjustments to the underlying structures while the soft tissue envelope remains largely intact.

This approach relies heavily on the surgeon’s tactile feedback and experience rather than direct visualisation. The technique is limited to cases requiring minor modifications where structural grafting is not anticipated and where precision in cartilage work is less critical.

Why Modern Practice Favours Open Rhinoplasty

Predictability Through Direct Visualisation

One of the most significant advantages of open rhinoplasty is its enhanced predictability compared to closed techniques. In closed rhinoplasty, the nasal tip position depends heavily on unpredictable healing and scar tissue formation. The surgeon cannot directly see the structures being modified and must rely on tactile assessment to gauge results.

Open rhinoplasty eliminates this uncertainty. The surgeon can directly visualise all nasal structures, precisely position cartilage grafts, and assess results during the procedure. This creates significantly more predictable outcomes, allowing the tip to be set to the exact desired position with confidence that it will maintain that position long-term.

Structural Grafting for Lasting Results

The reliability of modern rhinoplasty rests primarily on the strategic use of cartilage grafts to create permanent structural support. Each graft type serves specific functions that contribute to long-term stability:

Columellar Strut Grafts provide essential nasal tip support, preventing the projection loss and rotation changes that can occur when relying solely on native cartilage strength. Precise placement of these grafts requires the direct access that only open rhinoplasty provides.

Spreader Grafts maintain internal nasal valve patency and preserve aesthetic dorsal lines. When a dorsal hump is removed, the upper lateral cartilages lose their connection to the septum, creating a tendency for collapse over time. Spreader grafts prevent this delayed complication by providing permanent structural support.

Septal Extension Grafts offer superior long-term tip stability compared to other techniques. Studies demonstrate that septal extension grafts maintain tip projection and rotation more effectively over time, but their precise placement demands the visualisation afforded by open rhinoplasty.

Functional Correction Capabilities

For patients with breathing difficulties, open rhinoplasty offers comprehensive access to address structural problems. Functional rhinoplasty allows the surgeon to visualise and correct directly:

• Septal deviations affecting airflow
• Collapsed nasal valves causing breathing obstruction
• Weakened alar cartilages leading to nostril collapse during inhalation
• Internal valve narrowing compromising nasal function

Functional rhinoplasty frequently requires structural grafting to strengthen and support the nasal airway. This work demands the precision and visualisation that open rhinoplasty provides—attempting such corrections through a closed approach significantly increases the risk of inadequate or unpredictable results.

Tip Modification Precision

Nasal tip surgery requires meticulous precision. The open approach provides direct access to the lower lateral cartilages, allowing surgeons to employ sophisticated suturing techniques, cartilage reshaping, and grafting manoeuvres with clear visualisation of results.

Closed rhinoplasty significantly limits what can be achieved with the nasal tip. Without direct visualisation, surgeons cannot employ the advanced structural techniques that produce refined, symmetrical, and stable tip results. Complex tip work—involving multiple sutures, grafts, or significant cartilage modification—is fundamentally better suited to the open approach.

Revision Surgery Requirements

Secondary rhinoplasty procedures present particular challenges: scar tissue obscures anatomy, previous surgery has altered normal structures, and grafting is frequently required to reconstruct compromised frameworks. Open rhinoplasty is strongly preferred for revision work because:

• Direct visualisation allows assessment of existing structural damage
• Scar tissue can be identified and managed under direct vision
• Precise graft placement is possible despite altered anatomy
• The surgeon can assess the adequacy of reconstruction during the procedure

Attempting significant revision work through a closed approach substantially increases the difficulty and reduces the predictability of outcomes.

The Limitations of Closed Rhinoplasty

While closed rhinoplasty avoids an external incision, this advantage comes with significant trade-offs that limit its applicability in modern practice.

Restricted Visualisation

The fundamental limitation of closed rhinoplasty is the surgeon’s inability to directly visualise the nasal structures being modified. All work must be performed through narrow internal access points, with the surgeon relying on tactile assessment rather than visual confirmation.

This restriction has profound implications:

• Graft placement accuracy is compromised
• Symmetry is more difficult to assess and achieve
• Subtle structural problems may not be identified
• The surgeon cannot directly confirm results during the procedure

Reliance on Unpredictable Healing

Closed rhinoplasty results depend heavily on how tissues heal and how scar tissue forms—factors that vary significantly between patients and cannot be precisely controlled. The final nasal tip position emerges from the interplay of tissue contraction, scar formation, and cartilage memory rather than from precise surgical positioning.

This reliance on healing variables introduces unpredictability that open structured techniques specifically aim to eliminate.

Inadequate for Structural Work

Modern rhinoplasty increasingly recognises that lasting results require structural support through cartilage grafting. Closed rhinoplasty’s limited access makes precise graft placement extremely difficult, if not impossible. Spreader grafts cannot be positioned with the required accuracy for optimal function; tip grafts risk malposition without direct visualisation; complex structural reconstruction is not feasible; and the surgeon cannot assess graft integration during the procedure.

Limited Functional Correction

Patients seeking improvement in nasal breathing require surgical access to internal structures that closed rhinoplasty cannot adequately provide. Valve reconstruction, septal work, and structural grafting for airway support all benefit substantially from direct visualisation.

Attempting functional corrections through a closed approach may result in incomplete treatment, unpredictable outcomes, or the need for subsequent revision surgery.

Special Considerations for Different Patient Groups

Ethnic Rhinoplasty

Ethnic rhinoplasty requires particular attention to preserving cultural identity while addressing individual concerns. Open rhinoplasty is frequently preferred for ethnic rhinoplasty because it allows precise structural modifications that respect and enhance each patient’s unique nasal characteristics. The direct visualisation enables surgeons to work with thicker skin envelopes, address specific cartilage configurations, and achieve refined results while maintaining ethnic identity.

Male Rhinoplasty

Male rhinoplasty presents distinct anatomical considerations, including thicker skin, stronger cartilage, and the need to preserve masculine nasal characteristics. Open-structured techniques are particularly valuable for male patients because enhanced visualisation allows surgeons to make precise modifications while avoiding over-refinement that might feminise the nose.

Teen Rhinoplasty

Teen rhinoplasty requires careful consideration of nasal development and growth. When surgery is appropriate for younger patients, the precision of open rhinoplasty becomes especially important to achieve results that will remain balanced as facial structures mature.

Considerations for Open Rhinoplasty

The External Incision

Open rhinoplasty requires a small incision across the columella. In most patients, this heals well and becomes difficult to detect within 6 to 12 months. Individual healing varies, and some patients may experience more visible scarring. However, for most patients, this minor trade-off is substantially outweighed by the improved precision, predictability, and long-term stability that open rhinoplasty provides.

Recovery Characteristics

Open rhinoplasty involves more extensive tissue elevation than closed techniques, which generally results in greater initial swelling. Swelling typically peaks within the first 72 hours and progressively subsides, with the majority resolving within the first few weeks.

Residual fine swelling—particularly at the nasal tip—may persist for twelve to eighteen months before final contours become fully apparent. This extended settling period reflects the comprehensive nature of structural work rather than a disadvantage of the technique.

Operative Duration

Open rhinoplasty generally requires additional surgical time to perform the detailed structural work that produces lasting results. This represents an investment in precision and durability rather than a limitation of the approach.

What Does the Evidence Indicate?

Clinical evidence supports open, structured rhinoplasty as a reliable technique that produces predictable results. Studies demonstrate significant improvements in patient-reported outcomes, with revision rates below average despite the method being used for more complex cases.

The evolution toward structural approaches reflects accumulated evidence that techniques prioritising reinforcement over reduction produce more durable, stable outcomes that endure in the long term.

Consultation with Dr Scott J Turner

Dr Scott J Turner offers rhinoplasty consultations at his clinics in Sydney and Brisbane. As a Fellow of the Royal Australasian College of Surgeons (FRACS), Dr Turner has completed extensive training in plastic and reconstructive surgery and employs modern structural techniques designed to produce lasting, stable results.

Patients considering rhinoplasty should understand that results vary between individuals based on skin thickness, healing characteristics, and underlying anatomy. Final results take time to emerge—while initial changes are visible once swelling subsides, the nose continues to settle over twelve to eighteen months. A proportion of patients require revision procedures to address issues that become apparent during healing. Rhinoplasty can modify nasal structure, but cannot guarantee satisfaction with one’s appearance or resolve concerns unrelated to the nose itself.

Book a Consultation in Sydney or Brisbane

If you are considering rhinoplasty surgery, Dr Scott J Turner offers comprehensive assessments at his Sydney and Brisbane clinics. As a Specialist Plastic Surgeon specialising in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and recommend the most appropriate surgical approach.

To arrange your consultation, please contact us or telephone 1300 437 758.

Learn more about Dr Turner’s nose surgery procedures.