Open Rhinoplasty Technique

In open rhinoplasty, a small incision is made on the columella (the thin skin between the two nostrils), and the skin of the nose is completely lifted so that the surgeon has a direct and extensive view of the cartilaginous and bony skeleton. According to Dr. Hosnani, this method is more suitable for complex cases such as fleshy noses, cases requiring cartilage reinforcement, severe nasal tip correction, or revision surgeries, because it provides greater precision and control in shaping the tip and creating symmetry, and the incision mark usually becomes very faint and almost invisible after a few months.
 In open rhinoplasty, the surgeon makes a small incision on the columella—the narrow strip of skin that separates the nostrils—and then lifts the nasal skin upward like a “cover.” This allows all underlying structures, including: the cartilages,
the bones,
the nasal septum,
the soft tissues
to be fully exposed. Because of this direct visibility, surgical precision increases and complex corrections become possible.

Steps of Open Rhinoplasty

1. Anesthesia
The operation is usually performed under general anesthesia.
 2. Creating the Columellar Incision
A delicate incision is made in the middle of the columella. This incision is only a few millimeters long and becomes almost invisible after healing.
 3. Separating and Lifting the Skin
The skin is gently separated from the nasal framework so that the internal structures are fully visible.
 4. Structural Reshaping
At this stage, the surgeon can:
✔ remove the hump
✔ reshape the bones
✔ strengthen or reduce the cartilages
✔ straighten a deviated septum
✔ refine the nasal tip with high precision
✔ place cartilage grafts


 5. Repositioning the Skin and Closing the Incisions
At the end of the procedure, the skin is placed back in its position and the columellar incision is closed with fine sutures.
 6. Applying the Splint
A splint is placed on the nose to keep the bones stable.

Advantages of Open Rhinoplasty

1. Wide and Direct View of Nasal Structures

The greatest advantage of this technique is complete visibility, which allows the surgeon to perform the following with maximum precision:
✔ complex nasal tip correction
✔ straightening a deviated septum
✔ improving symmetry
✔ placing grafts
✔ revising noses that have previously been operated on


2. The Most Suitable Method for Difficult and Complex Noses

The open technique is the best option for the following types:
✔ fleshy noses
✔ bony noses with severe deviation
✔ wide or drooping nasal tips
✔ noses that require cartilage grafting
✔ revision rhinoplasty
✔ damaged or deformed noses


3. Precise Nasal Tip Shaping

In the closed technique, control over the nasal tip is more limited.
However, in the open technique, the surgeon can raise or lower the tip, narrow it, strengthen weak cartilages, correct drooping, and perform precise modeling.

4. More Stable Results

Because the surgeon can reinforce the nasal structure more effectively, results with the open technique are usually more stable and standardized.

Disadvantages and Limitations of Open Rhinoplasty

1. More Swelling

Because the skin is separated, nasal swelling is slightly greater and lasts somewhat longer in the open technique compared with the closed technique.
However, after a few months, no noticeable difference remains.

2. A Small Columellar Incision

A fine line is created on the columella, but:
✔ it is very small
✔ with proper technique, it usually becomes unnoticeable
✔ after a few months, it blends with the skin color

3. Longer Operating Time

Because the work is more extensive, the operation usually takes 15 to 30 minutes longer than the closed technique.

How Visible Is the Columellar Scar?

The columellar incision is one of the concerns patients often have, but in reality:
the incision is very delicate
it is located in a natural skin crease
it is closed with precise sutures
it becomes almost faded after 2 to 3 months
in most patients, even close family members do not notice it.

Recovery and Healing After Open Rhinoplasty

1. During the First Week, the Splint Remains on the Nose

Bruising around the eyes may be present, and swelling is slightly greater than with the closed technique.

2. From the Second to the Fourth Week

Most bruising disappears
Swelling decreases
Daily activities can be resumed

3. From the First to the Third Month

About 60 to 70 percent of swelling decreases
The shape of the nose becomes clearer

4. One Year After Surgery

The final result becomes completely visible
The nasal tip changes the most during this period

Who Is the Best Candidate for Open Rhinoplasty?

This method is suitable for individuals who:
have a fleshy nose
have a wide, large, or drooping nasal tip
have a crooked or deviated nasal septum
need complex corrections
have previously undergone rhinoplasty and need revision
want high surgical precision and control
Is closed rhinoplasty better or open rhinoplasty?
No method is absolutely superior; the choice depends on the type of nose and the patient’s goals.

In General:

For simple and straightforward noses, the closed technique is suitable.
For complex, fleshy, deviated, or revision noses, the open technique is the best choice.
Most experienced surgeons prefer the open technique for precise procedures and to ensure stable results.