Open vs Closed Approach: Understanding the Difference

One of the most common questions patients ask ahead of revision rhinoplasty is: will I need an open or closed procedure? The answer depends on the nature and extent of the corrections required.

The Closed (Endonasal) Approach

In a closed rhinoplasty, all incisions are made inside the nostrils, leaving no visible external scarring. The procedure offers a faster recovery and less post-operative swelling. However, the surgeon's visibility and access to nasal structures is more limited — which is why the closed approach is generally reserved for less complex revision cases.

The Open (External) Approach

The open rhinoplasty approach involves a small additional incision across the columella — the strip of skin between the nostrils. This incision heals to become virtually imperceptible within several months. In return, the surgeon gains dramatically improved visibility and access to all nasal structures. This is especially important when placing rib cartilage grafts or rebuilding complex frameworks.

"For the majority of revision cases, the open approach is not a choice — it is a necessity. You cannot reliably rebuild what you cannot clearly see."

Why Most Revisions Require the Open Approach

Revision rhinoplasty almost always involves complex structural work — placing grafts, releasing scar tissue, rebuilding frameworks, or correcting significant asymmetries. These tasks require the direct visualisation that only the open approach provides. If you're considering revision surgery, understanding this trade-off is essential.

Scarring — What to Expect

The columellar scar from an open approach typically heals progressively. By three to six months it is generally flat and well-healed. By twelve months, it is typically very faint and effectively invisible in normal social situations. Read more about the full recovery timeline.