Closed Rhinoplasty and Its Difference from Open Rhinoplasty

Dr. Hamidreza Hosnani

ENT Specialist | Rhinoplasty Surgeon in Tehran | Nose Surgery Specialist

Decision Making

Rhinoplasty Candidate ♦ Choosing a Rhinoplasty Surgeon ♦ Criteria for Nose Aesthetics ♦ Factors Affecting Surgery Results ♦ Cost of Rhinoplasty ♦ Difference Between Female and Male Noses ♦ Difference Between Open and Closed Methods ♦ Psychological Tips ♦ Duration of Rhinoplasty ♦

Closed rhinoplasty is a surgical method where all incisions are made inside the nose, and there are no external incisions on the skin. This method is less invasive, takes less time (usually 1 to 2 hours), leaves no suture marks, and involves a faster recovery (about 1 to 2 weeks). It is suitable for small and moderate changes in the nasal structure, such as correcting a hump or the nasal tip, but the surgeon's access to the inside of the nose is more limited and may not be suitable for complex cases.

Advantages of Closed Rhinoplasty

In closed rhinoplasty, all incisions are made inside the nose, so no scar remains on the external nasal skin. In addition, swelling and tissue trauma are usually less, and some patients experience a shorter recovery period, although the choice of this technique depends on the type of nose and the surgeon’s opinion.

What is Closed Rhinoplasty?

Closed rhinoplasty is a surgical technique where all incisions are made inside the nostrils. Unlike the open approach, the skin of the nose is not lifted by making an external incision. In this technique, the surgeon gains access to the nasal bone and cartilage through these internal incisions to perform the necessary modifications. Because there is no incision on the columella (the tissue between the nostrils), no visible scar remains on the nose.

Who is a Good Candidate for Closed Rhinoplasty?

Closed rhinoplasty is primarily suitable for individuals who require moderate or limited structural changes to their nose.

Typically, this method is ideal for:

Removing a nasal hump
Correcting mild nasal deviation
Narrowing the nasal bones
Minor refinement of the nasal tip
Improving nasal symmetry
Adjusting nasal shape without extensive structural reconstruction

Conversely, for noses requiring extensive reconstruction or revision surgery, the open approach is often preferred.

Closed rhinoplasty method

In closed rhinoplasty, no columellar incision is made.

Procedure Steps for Closed Rhinoplasty

Closed nose surgery is usually performed under general anesthesia and typically takes about 1 to 2 hours.

Key Stages of the Surgery:

1. Creating Internal Incisions

The surgeon makes incisions inside the nostrils to access the bone and cartilage structure.

2. Modifying the Nasal Structure

Depending on the patient's needs, the following may be performed:

Removal of nasal humps
Correction of a deviated septum (septoplasty)
Narrowing of the bones (osteotomy)
Refinement or reinforcement of the nasal tip

3. Reshaping the Nose

The cartilage and bones are adjusted to achieve the desired shape.

4. Closing Incisions and Applying a Splint

After surgery, internal incisions are closed, and a nasal splint or cast is placed on the nose to protect the new structure.

Closed Rhinoplasty Is a Method of Nose Surgery

Closed rhinoplasty is a nasal surgery technique in which all incisions are made inside the nostrils and no incision is made on the external skin of the nose. In this method, the surgeon performs the necessary changes on the nasal bone and cartilage through these internal incisions. For this reason, it usually causes less swelling and has a faster recovery period, but the surgeon’s access and visibility are more limited compared with the open technique.

Advantages of Closed Rhinoplasty

This method offers several significant benefits compared to the open technique:

No External Scars

Since the incisions are internal, no visible scarring remains on the nasal skin.

Less Swelling

In many cases, post-operative swelling is reduced compared to the open method.

Shorter Surgical Time

Due to the limited nature of the incisions, the total surgery time is typically shorter.

Faster Recovery

Patients generally return to their daily activities more quickly.

Closed Method

In Closed Rhinoplasty, There Is No External Incision and All Surgical Steps Are Performed Through the Nostrils

Limitations of Closed Rhinoplasty

Despite these advantages, this method is not suitable for everyone. Its limitations include:

The surgeon’s visibility of the nasal structure is more limited.
Complex nasal tip corrections are more difficult to execute.
It is generally not suitable for revision surgeries.
It may not be sufficient for very fleshy noses or cases requiring significant structural changes.

For these reasons, the choice between an open and closed approach should be made by an experienced surgeon.

Difference Between Closed and Open Rhinoplasty

In open rhinoplasty, a small incision is made on the columella, allowing the nasal skin to be lifted. This provides the surgeon with a clearer view of the internal structures.

In contrast, in closed rhinoplasty:

There is no external incision.
The nasal skin is not completely lifted.
The surgeon's access is more limited.

Both methods can produce excellent results when performed by a skilled surgeon.

Difference in the application of the open and closed methods

In closed rhinoplasty, all incisions are made only inside the nostrils and there is no external incision on the columella, so the skin is not fully lifted and the surgeon’s view is more limited. This difference makes open rhinoplasty more suitable for complex noses requiring major changes, while closed rhinoplasty may be chosen for milder changes and for patients who prefer a shorter recovery period and no external incision.

Recovery Period After Closed Rhinoplasty

The healing process for this method is generally similar to other types of nose surgery.

General stages of recovery:

First week: Splint on the nose.
Second week: Reduction in bruising and swelling around the eyes.
First month: Significant reduction in swelling.
6 to 12 months: Full observation of the final result.

Following the surgeon's post-operative instructions carefully plays a crucial role in achieving the desired outcome.

Is the result of closed rhinoplasty permanent?
Yes. Rhinoplasty results are generally permanent. Once the bone and cartilage have fully healed, the new shape of the nose will be stable. However, factors such as skin thickness, cartilage quality, surgical technique, and post-operative care influence the quality of the final result.

Video: Closed Rhinoplasty: Nose surgery without external incisions; see how it's done!

In this procedure, closed rhinoplasty was performed on a female patient—a technique involving no external incisions or visible stitches, which promotes faster healing without leaving surgical scars. The video demonstrates the patient's nose from various angles (side, front, top, and bottom views) both before and after surgery inside the operating room. This allows for a clear view of the changes made. A few seconds of the surgical process are included to provide insight into the delicate and specialized technique required. These images effectively showcase structural and aesthetic improvements from all angles, demonstrating how the closed technique achieves a balanced and natural nose shape without external cutting.

Open Rhinoplasty Method

In Open Rhinoplasty, a Small Incision Is Made on the Skin of the Columella to Allow Better Access to the Internal Nasal Structures