Modern Rhinoplasty: Is There a Place for the Closed Approach?

Overview

Rhinoplasty can be done through incisions hidden entirely inside the nostrils, the closed or endonasal approach, or with an added small external incision that lifts the skin, the open approach. The author notes that most surgeons today prefer the open technique for its wider exposure, and makes the case for keeping the endonasal technique in use. This is an opinion and technique review with no patient series reported.

Sections of note

• Rhinoplasty is described as one of the most commonly performed cosmetic surgeries and often elective.
• The author states that accurate assessment of both function and appearance must come before choosing a strategy.
• Two approaches are contrasted: open, favored for access to the nasal framework and overview of the surgical field, and closed.
• Endonasal techniques and their benefits are highlighted, with discussion of situations where they give superior results.
• The stated principle is matching each approach to the nasal condition and the desired result.
• The conclusion is that open surgery is not always necessary and may be disadvantageous in some cases.
• The abstract reports no patient numbers, comparison data, complication rates, or follow-up.

What it means for a patient

• Neither approach is universally correct; the right one depends on what needs to change in your nose.
• The closed approach avoids the small external scar under the columella and involves less lifting of the skin.
• The open approach gives the surgeon direct sight of the framework, which matters for complex reshaping.
• This paper is expert opinion without measured outcomes, so it does not show one approach producing better results than the other.

Why this paper matters

The field has shifted heavily toward open rhinoplasty over the past few decades, and this paper pushes back against that as a default. Skill in both approaches widens what a surgeon can offer. The abstract offers no comparative evidence to settle which noses genuinely do better closed.

Terms

• Endonasal or closed rhinoplasty: Surgery done entirely through incisions inside the nostrils.
• Open rhinoplasty: Surgery using an added small incision across the columella to lift the skin.
• Columella: The strip of tissue between the nostrils.
• Nasal scaffold: The framework of cartilage and bone that gives the nose its shape.
• Elective procedure: An operation chosen rather than medically required.