Closed Approach Rhinoplasty

Rhinoplasty can be performed through two fundamental approaches — open and closed. The closed approach places all incisions entirely inside the nose, leaving no external scars. Understanding the differences between the two approaches — and which is more appropriate for a given patient’s anatomy and goals — is an important part of rhinoplasty planning.

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What is Closed Rhinoplasty?

A closed rhinoplasty — also called endonasal rhinoplasty — is one in which all surgical incisions are made on the inside of the nose. There are no external incisions and therefore no visible scars on the outside of the nose. The surgeon works through the nostrils to access and modify the underlying nasal structures.

The closed approach can address a range of rhinoplasty goals including:

• Modification of the nasal dorsum (bridge)
• Reduction of a dorsal prominence using preservation or conventional techniques
• Correction of a deviated nasal septum (septoplasty)
• Narrowing of the nasal width through osteotomies
• Selected tip modifications where access through the nostrils is sufficient

Advantages of the Closed Approach

Limitations of the Closed Approach

The closed approach provides less direct visualisation of the nasal structures than the open approach — the surgeon works “blind” to some extent, relying on experience and tactile feedback. This limits what can be reliably achieved through a closed approach:

• Complex tip work — significant reshaping or reconstruction of the nasal tip cartilages is difficult without direct visualisation and is generally performed through the open approach
• Cartilage grafting — placing, shaping, and securing cartilage grafts precisely is challenging through a closed approach; most grafting procedures are performed open
• Revision rhinoplasty — almost always performed through the open approach, as the changes from previous surgery need to be directly visualised and assessed before any repair can be planned

Which Approach is Right for Me?

The choice of approach depends on the specific goals of surgery, the complexity of the changes required, and the individual’s anatomy. For patients whose goals can be reliably achieved through a closed approach — typically those involving dorsal work, septoplasty, or selected simple tip modifications — the closed approach may be preferred. For patients requiring significant tip reshaping, structural reconstruction, cartilage grafting, or revision surgery, the open approach is almost always preferred.

Dr Roth will discuss the most appropriate approach for your specific anatomy and goals at consultation. A comparison of preservation rhinoplasty and open structure rhinoplasty — the two main approaches to more comprehensive rhinoplasty — is available here.

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