The two approaches
Rhinoplasty is carried out one of two ways. In a closed procedure, every incision is hidden inside the nose, on the inner surface of the nostrils. In an open procedure, those same internal incisions are joined by one more: a small cut across the columella, the narrow strip of tissue separating the nostrils (ASPS). Both approaches reshape the same structures underneath — bone, cartilage, the tissue that gives the nose its shape. The difference is how the surgeon reaches them, not what can be changed once inside.
What each gives the surgeon
Closed rhinoplasty leaves no external scar, because every incision sits inside the nostril. It is worked through a narrower opening, with the skin of the nose left closed over the structures being reshaped. Open rhinoplasty lifts the skin off the cartilage and bone through the columellar incision, giving direct, unobstructed visibility of the entire nasal framework at once, rather than working through two separate nostril openings. That visibility is the trade against the scar: more of the nose is seen and handled directly, at the cost of one incision on the outside.
The columellar scar
The columellar incision sits in a natural crease, at the narrowest point of the nose, where it is not read as a scar on the face at a normal viewing distance once healed. It is not scarless, and it is not invisible in the first weeks — like any fresh incision, it is a visible line to begin with, and it fades over the following months. It is a different thing from a scar on an exposed part of the face, both in where it sits and in how a fine, well-placed line like this settles.
How the choice is made
Neither approach is better as a rule. Closed rhinoplasty is suited to a nose that needs limited, defined changes, reached well through the internal route. Open rhinoplasty is suited to a nose that needs more extensive reshaping, or where the surgeon needs to see the full framework at once to plan grafts or correct asymmetry. Which one fits is a question about that specific nose and what needs to change in it, not a ranking of one technique over the other. It is worked out at the consultation, examining the nose and the goals for it, not decided in advance.
Recovery is similar either way
Swelling, bruising and the splint follow broadly the same course whichever incision was used, because the reshaping of bone and cartilage inside the nose, the main cause of both, is the same in both approaches. The stage-by-stage timeline, from the first week to the year it takes for the final contour to settle, is covered in rhinoplasty recovery: what to expect.
When a nose has already been operated on
A second operation on a nose that has already been reshaped once starts from anatomy that surgery has already changed, with scar tissue in place and cartilage already used. The added visibility of the open approach is useful in that setting, for the same reason it helps with a more extensively reshaped first nose: seeing the whole framework at once, rather than working through it blind. What a revision involves, and why it differs from a first operation, is covered in revision rhinoplasty.
Risks, in plain words
- Bruising and swelling around the eyes and nose in the early weeks.
- A columellar scar, in the open approach, that is visible while it heals and fades over the following months.
- Breathing difficulty, temporary or lasting.
- A change in the sense of smell.
- A result that needs a further operation to fully correct.
At this practice
Dr. Vincent ElKhoury, a board-certified plastic and reconstructive surgeon, operates on every rhinoplasty case himself, at Hayek Hospital or Bellevue Medical Center. Which approach fits a given nose is examined at the consultation, at his clinic in Mansourieh, Metn, before any decision is made. Further detail on what the operation involves is on the rhinoplasty in Lebanon page.
Questions
FAQ
What is the difference between open and closed rhinoplasty?
Closed rhinoplasty uses incisions hidden inside the nostrils only. Open rhinoplasty adds one more incision, a small cut across the columella, the strip of tissue between the nostrils, which lifts the skin off the underlying bone and cartilage for direct visibility of the whole nasal framework.
Does open rhinoplasty leave a visible scar?
It leaves a scar across the columella, in a natural crease at the narrowest point of the nose. It is a visible line in the early weeks, like any fresh incision, and fades over the following months. Closed rhinoplasty, with incisions only inside the nostrils, leaves no external scar.
Which technique is better, open or closed rhinoplasty?
Neither is better as a rule. Closed rhinoplasty suits limited, well-defined changes reached through the internal route. Open rhinoplasty suits more extensive reshaping or a case where the surgeon needs to see the full framework at once. Which fits depends on the nose and what needs to change, worked out at the consultation.
Is recovery different after open versus closed rhinoplasty?
Recovery follows broadly the same course either way, because the swelling and bruising come mainly from the reshaping of bone and cartilage inside the nose, which happens in both approaches. The stage-by-stage timeline is covered in the rhinoplasty recovery article.