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Open structure rhinoplasty

Open structure rhinoplasty is a surgical technique used to reshape and reconstruct the nose. It involves creating an external incision to provide better visibility and access to the nasal structures. Here’s a detailed description of the procedure:

Preoperative Planning

  1. Consultation: The patient meets with the surgeon to discuss their goals and expectations. The surgeon evaluates the nasal structure, skin type, and facial proportions.
  2. Facial Analysis:
    1. Anthropometric Measurements: Precise measurements of nasal length, width, projection, and angles (nasofrontal, nasolabial, and nasofacial angles).
    2. Skin Quality: Assessment of skin thickness, elasticity, and sebaceous characteristics, which influence healing and final outcome.
  3. Functional Evaluation:
    1. Breathing Assessment: Evaluation of nasal airflow and obstruction.
    2. Septal Deviation: Detailed examination of any septal deviations contributing to breathing issues.
  4. Imaging: Photos and sometimes computer imaging are used to plan the surgery and simulate potential outcomes.
  5. Medical Evaluation: A thorough medical history and examination are conducted to ensure the patient is a good candidate for surgery.


  • General Anaesthesia: Typically, the patient is placed under general anaesthesia to ensure comfort and safety throughout the procedure.

Surgical Procedure

  1. Incision:
    • A small incision is made across the columella (the tissue between the nostrils) and extended into the nostrils. This is known as a trans-columellar incision.
    • This approach provides direct access to the underlying nasal structures.
  2. Elevation of Skin:
    • The skin and soft tissues of the nose are gently lifted off the underlying framework of bone and cartilage.
    • This exposes the nasal structures, allowing for precise modifications.
  3. Reshaping the Cartilage and Bone:
    • Dorsal Hump Reduction: If there is a prominent dorsal hump, it is carefully reduced using rasps, chisels, or other instruments.
    • Tip Refinement: The cartilage of the nasal tip (lower lateral cartilages) can be reshaped, reduced, or augmented to achieve the desired contour.
    • Nasal Width Adjustment: If the nose is too wide, the nasal bones can be fractured and repositioned (medial and lateral osteotomies) to narrow the nose.
    • Septum Correction: If there is a deviated septum or breathing issues, the septum can be straightened (septoplasty) to improve airflow.
  4. Grafting:
    • Cartilage Grafts: Cartilage from the septum, ear, or rib may be used to reinforce and support the nasal structure. Common grafts include spreader grafts, alar batten grafts, and columellar strut grafts.
    • These grafts provide structural support and help achieve the desired shape.
  5. Closing the Incisions:
    • Once the desired changes are made, the skin is redraped over the new framework.
    • The external incision is meticulously closed with fine sutures to minimize scarring.

Postoperative Care

  1. Splinting and Packing:
    • A nasal splint is applied to maintain the new shape and protect the nose during initial healing.
    • Internal nasal packing or splints may be used to support the septum and control bleeding.
  2. Recovery:
    • The patient may experience swelling, bruising, and discomfort, which are managed with medications and cold compresses.
    • Follow-up visits are scheduled to monitor healing and remove any non-dissolvable sutures, splints, or packing.
  3. Long-term Healing:
    • Swelling gradually subsides over several months, and the final results may take up to a year to become fully apparent.
    • The patient is advised to avoid strenuous activities, heavy lifting, and any trauma to the nose during the healing period.

Advantages of Open Rhinoplasty

  • Visibility: Provides excellent visualization of the nasal structures, allowing for precise modifications.
  • Versatility: Suitable for complex cases, including significant deformities, revisions, or extensive reshaping.
  • Control: Enhanced control over the reshaping process, especially for the nasal tip and dorsal structures.


  • Scarring: Although minimal, there is a small external scar on the columella.
  • Swelling: May result in more postoperative swelling compared to closed techniques.
  • Recovery Time: Slightly longer recovery time due to the more extensive surgical approach.

Overall, open structure rhinoplasty is a highly effective technique for achieving significant and precise nasal corrections, with the trade-off of a small external scar and potentially longer recovery.

Before and After Photos Sydney
Dr Jason Roth Associations