Open Approach Rhinoplasty

The open approach to rhinoplasty involves a small incision across the columella — the narrow strip of tissue between the two nostrils — allowing the skin of the nasal tip and dorsum to be elevated and the entire nasal framework to be visualised under direct vision. This provides the most complete surgical access available in rhinoplasty, and is the approach of choice for the majority of complex, reconstructive, and revision procedures.

Cosmetic surgery is a serious decision. Read the full rhinoplasty risks page →

The Columellar Incision

The defining feature of the open approach is the transcolumellar incision — a small, carefully placed cut across the midpoint of the columella, connecting to bilateral marginal incisions that run along the caudal edge of the lower lateral cartilages inside each nostril. When the skin between these incisions is elevated, the skin envelope of the nasal tip can be folded back like a hood, revealing the complete lower lateral cartilages, the middle vault, the nasal dorsum, and the caudal septum in their natural three-dimensional relationships.

The columellar incision is designed to follow the natural contour of the columella — typically a broken or inverted-V pattern that minimises the visibility of the scar by following the midline shadow. When properly placed and carefully closed, the columellar scar heals to a fine pale line that is not visible at normal social distance. In most patients, after six to twelve months the scar is very difficult to identify even under close inspection. Individual scar healing varies, and some patients develop a slightly more visible scar that may require scar management.

What the Open Approach Allows

Complete Visualisation of the Nasal Framework

The most important clinical advantage of the open approach is the ability to see the entire nasal framework under direct vision simultaneously. In the closed approach, the surgeon works through small openings inside the nostrils with limited visibility, relying on tactile feedback and experience to navigate the anatomy. In the open approach, the skin is elevated off the cartilaginous and bony skeleton, exposing the full extent of the structures to be modified. This allows the surgeon to assess existing asymmetries in the cartilage framework that may not be apparent from external examination, to make more precise corrections, and to place cartilage grafts under direct vision with greater accuracy.

Precise Suture Placement

Many of the most important manoeuvres in modern rhinoplasty rely on suture techniques — placing precisely positioned sutures to reshape, rotate, reposition, or stabilise the cartilage framework. In the closed approach, suture placement is technically challenging because access is limited. In the open approach, sutures can be placed under direct vision, in exactly the desired location, with real-time visual confirmation of the effect. This is particularly important for tip refinement, where the relationship between the medial and lateral crura must be precisely adjusted to achieve the planned tip shape.

Cartilage Graft Placement

Cartilage grafts are used in rhinoplasty to restore structural support, reinforce the nasal framework, add projection, or address valve problems. Grafts used in open rhinoplasty include spreader grafts (placed between the dorsal septum and upper lateral cartilage to maintain or restore the middle vault), columellar strut grafts (placed between the medial crura to increase tip support and projection), cap grafts (placed at the tip-defining point to increase definition), and lateral crural strut grafts (placed beneath the lateral crura to correct collapse or external valve insufficiency). All of these grafts are placed with greater precision and security through the open approach, because they can be positioned and stabilised under direct vision.

Assessment and Correction of Asymmetry

Nasal asymmetry — differences between the left and right sides of the nasal framework — is present in every nose and is often more pronounced than external examination suggests. Under direct vision in the open approach, the three-dimensional character of these asymmetries can be assessed and addressed with a precision that is not possible through a closed approach. This is one of the primary reasons the open approach is preferred for revision rhinoplasty, where new asymmetries may have been introduced by the original surgery.

When the Open Approach is Used

The open approach is not required for every rhinoplasty. The decision between open and closed technique — or between open structure and preservation rhinoplasty — depends on what is being addressed and the degree of access, modification, and grafting required.

Recovery After Open Rhinoplasty

Recovery after open rhinoplasty follows the same general timeline as closed rhinoplasty, with some additional considerations related to the columellar incision. The columellar scar is covered with a small strip of tape or suture material in the immediate post-operative period. External sutures are typically removed at the one-week visit, when the nasal splint is also removed. The columellar area may feel slightly stiff or numb in the weeks following surgery — this is normal and resolves over several months as sensation returns.

Swelling after open rhinoplasty is generally comparable to or slightly greater than after a closed approach, reflecting the more extensive skin elevation involved. Tip swelling in particular is prolonged — often the most persistent component of post-operative swelling — and can take twelve to twenty-four months to fully resolve in patients with thicker skin.

Full post-operative care instructions are provided at the pre-operative appointment and available on the post-operative care page.

Open Approach vs Other Rhinoplasty Approaches

For a detailed comparison of open, closed, and preservation rhinoplasty techniques — including their respective indications, advantages, and trade-offs — see the following pages:

• Open Structure Rhinoplasty →
• Closed Approach Rhinoplasty →
• Preservation Rhinoplasty →
• Preservation vs Open Structure — Comparison →

Rhinoplasty Surgery Overview → | Rhinoplasty Risks → | Arrange a Consultation →

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Speak with Dr Jason Roth

Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.

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(02) 9982 3439

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.