APS Aesthetic Plastic Surgery · 2026

Closed Structural Rhinoplasty

Clark RP, Farajzadeh MM, Wong GB.

PubMed 40956325 Publisher (DOI)Free full text (PMC)

What this paper says

The senior author describes endonasal techniques developed over 39 years for passing tip sutures and placing grafts through a closed approach, and reports that 11% of surveyed ASPS surgeons said more than a quarter of their open-rhinoplasty patients had columellar scars noticeable at intimate distance.

Overview

Closed rhinoplasty was once limited to reduction because structural tip sutures were hard to place without opening the nose. Clark and colleagues describe and demonstrate on video how to replicate open-approach tip suturing through the delivery technique of closed rhinoplasty. A survey of American Society of Plastic Surgeons members assessed how often the open-approach scar is a problem.

Sections of note

Techniques developed over 39 years by the senior author; videos and photographs demonstrate them.
Closed advocates named: Sheen, Constantian, Guerrerosantos, Bravo, Kamburoglu, Tezel, Ersoy, Cakir, Valdivia.
Most surgeons still prefer the open approach and regard the scar as an innocuous necessity.
ASPS survey: 11% of respondents reported that over 25% of their patients' scars were noticeable at intimate distances.
Level of Evidence V.

What it means for a patient

Structural tip work with permanent sutures can be done without an external scar in experienced hands.
The columellar scar of open surgery is usually inconspicuous, but a minority of surgeons report frequent noticeable scars.
The paper is a technique demonstration, not an outcome comparison.

Why this paper matters

It argues, with technique detail, that the closed approach need not sacrifice structural control. Limits: expert opinion, survey response details not given, no patient outcomes.

Terms

Closed (endonasal) rhinoplasty: all incisions inside the nose.
Delivery technique: bringing the tip cartilages out through nostril incisions to suture them under direct view.
Structural rhinoplasty: reshaping by adding sutures and grafts for support rather than removing tissue.
Columellar scar: the external scar of open rhinoplasty across the strip between the nostrils.
ASPS: American Society of Plastic Surgeons.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Closed rhinoplasty had initially been relegated to a reductive procedure that did not provide access to place structural sutures for tip support. Despite the influence of closed rhinoplasty advocates Sheen, Constantian, Guerrerosantos, Bravo, Kamburoglu, Tezel, Ersoy, Cakir, Valdivia and others who have produced excellent results, most surgeons prefer the open approach. The scar resulting from open rhinoplasty is considered a relatively innocuous necessity to achieve sophisticated results.

Methods: Endonasal methods to replicate the tip suturing techniques of open rhinoplasty were developed over 39 years by the senior author. This paper describes, and supplemental videos demonstrate, the tip suture passing and grafting techniques through the closed approach. To evaluate the frequency of columella scar negative consequences, a survey of ASPS members was done.

Results: Videos and photographic examples demonstrate the success of these original closed rhinoplasty suture techniques. In a survey of ASPS surgeons, 11% of respondents report that over 25% of patient's scars were noticeable at intimate distances.

Conclusion: Tip restructuring with permanent sutures can be readily done via the delivery technique of closed rhinoplasty without creating a columella scar that may be problematic.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).