Rhinoplasty Techniques in Zurich: Open vs Closed Explained

A breakdown of open vs closed rhinoplasty and guidance on choosing the ideal approach.

Rhinoplasty is a surgical procedure performed to reshape the nose and is one of the most common plastic surgery procedures. The terms 'open rhinoplasty' and 'closed rhinoplasty' do not actually refer to surgical techniques, but rather to the access route used to apply the techniques recommended for each specific case.

The choice of the ideal approach depends on the patient's specific anatomical deformity, the surgeon's experience, and the objectives of the surgery.

There are three fundamental approaches in nasal aesthetics:

Structural approach (usually open rhinoplasty):

In this approach, the nasal structures (cartilages) are removed or reshaped, and the support lost during this process is usually reinforced with cartilage pieces (grafts) taken from another area. It is suitable for major changes and is a flexible method that can be used in almost every case.

Preservation approach (usually closed rhinoplasty):

The aim of this approach is to preserve the natural structures of the nose as much as possible and to intervene as little as possible. It is suitable for people undergoing nose surgery for the first time and who want minor changes.

Hybrid approach:

Today, combining these two methods is preferred for the best results. For example, the upper part of the nose can be preserved using the 'preservation' method, while the tip of the nose can be reinforced using 'structural' methods. Doctors aim to preserve the natural structure of the nose as much as possible.

What are rhinoplasty techniques?

Rhinoplasty techniques are generally based on the fundamental philosophy of surgery (structural or reconstructive) and the access route used (open or closed). The ideal technique is determined according to the patient's anatomical deformity, the surgeon's experience, and the expected results.

Access routes

Open rhinoplasty

Open surgery is a method in which a small incision is made on the outside of the nose, allowing the structures of the nose to be fully visible. It is ideal for solving complex and difficult problems. It is preferred mainly in the following situations:

Closed rhinoplasty

• In closed surgery, the incision is made inside the nose and leaves no external scar. It is suitable for more limited and minor corrections.
• It is a reasonable option if a major change in the shape of the nose is not desired and only minor corrections are sufficient.
• It is advantageous for patients who only wish to have the nasal hump (bump) removed and do not require significant alteration to the nasal tip.
• The closed method is recommended if there is only a slight enlargement of the tip of the nose or if only a minimal lift is required.
• If the basic shape of the person's nose is already attractive and only very minor improvements are to be made, the closed method may be more appropriate to preserve this natural form.

Structural rhinoplasty:

• The fundamental principle of this approach is to strengthen and reinforce the structure by placing support rods (grafts) inside the nose.
• When certain tissues are removed or reduced during surgery, the nose may lose support. In structural aesthetics, this lost support is compensated for with cartilage pieces (grafts) taken from another location. In other words, 'new support is placed where it is lacking.'
• It is the most effective and almost the only solution, especially in previously performed and structurally compromised nose surgeries (revision).

Preservation rhinoplasty

• The fundamental philosophy of this approach is to preserve the natural structure of the nose as much as possible and minimize tissue removal.
• In the traditional method, the dorsal hump is cut and removed. In the preservation method, the hump is lowered as a whole. It can be thought of as lowering a door threshold. This preserves the natural integrity of the midline of the nose and reduces the need for additional support.

Structural preservation

This combines two methods to achieve the most ideal results. Preservation techniques are used for the upper part of the nose (dorsal line), while structural techniques (support grafts) can be applied to the tip of the nose. This preserves the natural structure while giving the tip of the nose the desired shape and durability.

Basic surgical techniques

Correction of the nasal bridge:

• Removal of the hump: This is the procedure to correct the hump or ridge on the nose.
• Traditional method: The hump is shaved off using tools such as a rasp or chisel.
• More precise method (component method): Cartilage layers are separated individually and reduced in a much more controlled and precise manner. This provides a more natural appearance.

Shaping the nasal tip:

• The nasal tip is the part of the surgery that requires the most delicate workmanship. The aim is to lift the tip of the nose, define its shape, make it symmetrical, and strengthen it.
• It involves reshaping the cartilage without cutting it, using special sutures. These methods are reversible and produce more natural results.
• Very small pieces can be removed from the edges of the cartilage to thin the tip of the nose and make it more defined.

Support grafts (cartilage grafts)

• Support rod (Columellar strut): A cartilage rod placed in the middle column of the nose to keep the tip upright and increase its projection forward.
• Shield graft: A shield-shaped piece of cartilage placed to give the tip of the nose a sharper and more defined appearance.

Narrowing of the bones (osteotomy)

• This is the process of breaking the nasal bones in a controlled manner and repositioning them.
• It is performed to narrow the remaining bones after removing the hump or to narrow already wide nasal bones.
• Tiny fractures are created with a very fine saw. This procedure can also be performed through a small incision in the skin, which may cause less bruising.

Augmentation (filling and support)

• This is performed to add volume and contour in cases where the nose is very small or flat.
• The cartilage used is usually taken from the patient's own nose, ear, or, very rarely, rib.
• Spreader grafts: Prevents the nasal midline from collapsing inward and facilitates breathing.
• Alar batten grafts: Prevent the nasal wings from collapsing, opening the airway and improving the side profile appearance.

Narrowing of the alar base

In cases where the nostrils are too wide, a small triangular piece is removed from under the nostrils to narrow them. This is usually the final step of the operation.

Closed rhinoplasty

Closed rhinoplasty is a surgical technique performed through incisions made inside the nostrils. As all procedures are performed inside the nose, there are no external incisions or stitch marks.

How is closed rhinoplasty performed?

Pre-operative preparation

Your surgeon will examine your nose and face in detail, take photographs, and create a personalized surgical plan for you using computer simulation.

Blood tests and, if necessary, other tests (such as an ECG or chest X-ray) will be performed to assess your general health.

You must inform your surgeon about all medications, vitamins, and herbal supplements you are taking. Medications that may increase the risk of bleeding (such as aspirin and certain painkillers) will need to be discontinued before surgery.

It is very important to stop smoking before surgery, as it slows down recovery and increases the risk of complications. Alcohol consumption is also restricted.

You will generally be asked not to eat or drink anything (including water) for 6-8 hours before surgery. This is to prevent the risk of nausea and vomiting during anesthesia.

General anaesthesia (more common)

You will be completely put to sleep with drugs administered intravenously by an anesthetist.

You will feel nothing during the operation. You will be in a deep sleep throughout the operation. When the operation is over, you will be woken up in a controlled manner in a special room.

Local anaesthesia + sedation

You will be made drowsy and relaxed with sedative drugs administered intravenously. Your nose will then be completely numbed with local anesthesia (as when having a tooth extracted).

You will not feel any pain or discomfort during the operation, but you may be aware of what is happening around you.

Incisions and access route

• The surgeon makes very small incisions inside your nostrils to access the working area.
• These incisions are made at the natural junctions of the cartilage.
• At the end of the operation, these internal incisions are closed with dissolvable stitches. Over time, these stitches disappear and leave no trace.

Methods for reshaping the nasal tip

There are two main methods used by surgeons to reshape the nasal tip:

Simple method

The cartilages are reshaped in place without being removed. This is suitable when only very slight changes to the nasal tip are desired. This method results in the fastest recovery with the least tissue trauma.

For example:

• Removal of a very slight bulge
• Very minor lifting

More comprehensive method

The cartilages are carefully removed through internal incisions and shaped under the surgeon's full view.

This is used when more pronounced changes are required to the nasal tip. The surgeon can work with more precise suture techniques by directly viewing the cartilages. For example:

• Correction of asymmetry (crookedness)
• Greater elevation or projection of the tip of the nose

Procedures performed

• Bony and cartilaginous protrusions on the bridge of the nose are removed with a rasp or chisel.
• Wide nasal bones are narrowed using controlled breaking techniques (osteotomy).
• The tip of the nose is refined, lifted, or reshaped by suturing the cartilage or through minor interventions.
• At the same time, breathing problems can be resolved by correcting the curvature inside the nose (septal deviation).

Advantages and disadvantages of closed rhinoplasty:

Advantages:

• As all incisions are made inside the nostrils, there are no external incisions or stitch marks. This is the most significant advantage.
• As the skin of the nose is not completely lifted, there is less tissue trauma and swelling. This means a quicker return to social life and faster reduction of swelling.
• Swelling, particularly at the tip of the nose, subsides more quickly compared to the open technique. It may take less time to see the final shape of the nose.
• As it involves less intervention technically, the surgery time is generally shorter.
• Since the blood flow to the nose's supporting structures and tissues is less affected, The natural anatomy is largely preserved.

Disadvantages

It is more difficult for the surgeon to see the operating area directly. Therefore, the surgeon's experience and manual dexterity become very important. As the surgeon's intervention is more limited, it is more difficult to make very large and complex changes.

It may not yield sufficient results in advanced problems such as the following:

• Secondary (revision) surgeries
• Deterioration following severe trauma
• Very serious asymmetry or deformity of the tip of the nose
• Situations where the nose needs to be significantly reduced or enlarged

Who is a suitable candidate for closed rhinoplasty?

• Those undergoing nose surgery for the first time,
• Those without significant or complex deformities of the nose,
• Those seeking minimal and natural changes,
• Those preferring a faster recovery process,
• Those who do not want any visible scarring.

Recovery process after closed rhinoplasty

First week:

Swelling and bruising: Swelling and bruising may occur around your eyes within the first 2-3 days. Swelling usually peaks on the third day. Applying cold compresses to your eyes helps reduce these symptoms.

Pain is usually mild and can be easily controlled with painkillers prescribed by your doctor. Most patients feel discomfort from nasal congestion rather than pain.

Your nose may remain blocked for 10-14 days, similar to a severe cold. A slight bloody discharge is normal in the first few days.

A plaster cast or plastic splint is placed over your nose to maintain its new shape and reduce swelling. This cast is removed by your doctor 7-10 days after surgery.

Precautions:

• It is very important to rest at home during the first week.
• You should not blow your nose for 3-4 weeks. You should only wipe it gently with a tissue.
• The internal nasal packing (if present) is usually removed during your check-up 1 week later.

1-6 Months:

Approximately 70-80% of the swelling subsides within the first month. The remaining 20-30% of persistent swelling, particularly at the tip of the nose, may persist for a longer period.

Numbness, stiffness, or a difference in the feel of smiling at the tip of the nose and upper lip is normal and will resolve within a few months.

After your cast is removed (7-10 days), you can return to your social life with slight swelling that can be camouflaged with makeup.

You should generally wait 3 weeks before engaging in sports other than light walking. You should avoid contact sports (such as football or basketball) for several months.

If you must wear glasses, ensure they are very lightweight.

Your nose is highly sensitive to the sun. Use high-factor sunscreen and a hat for at least 6 months.

6 Month - 2nd Year

• Approximately 90% of your nose will take shape within 6 months. However, it may take 1 to 2 years for the final, refined, and natural appearance to fully settle. It takes time for the final swelling at the tip of the nose to subside.
• It is very important to attend the follow-up appointments scheduled by your doctor during this long process. Your doctor will monitor your recovery and may perform minor interventions (such as cortisone injections) to reduce swelling if necessary.
• In rhinoplasty, there is always a possibility of minor irregularities due to the unpredictable healing of tissues. The rate of secondary surgery worldwide is between 5% and 20%. However, keep in mind that most minor problems resolve on their own over time. Therefore, it is necessary to wait at least 1 year before considering a possible revision.

Open rhinoplasty

Open rhinoplasty is a method performed by making a small incision on the outside of the nose so that the nasal structures can be fully seen and shaped. The procedure steps are as follows:

How is open rhinoplasty performed?

Preparation and anaesthesia

The surgery is usually performed under general anesthesia; the patient is put to sleep and feels nothing. Before the surgery, the surgeon marks the areas of the nose where he will perform the procedures with a special pen. In addition, a special anesthetic and vasoconstrictor medication is injected into the nose during the surgery to reduce bleeding.

Incision and opening of the skin

The defining step of the open technique is making a very small incision in the skin at the center of the nose, in the section separating the nostrils (columella). This incision is usually in the shape of a barely noticeable 'inverted V' or 'zigzag.' Starting from this incision, the surgeon carefully lifts the skin and underlying soft tissues away from the cartilage and bone structure. This allows the entire skeleton of the nose to become clearly visible.

Surgical procedures (shaping of the nasal skeleton)

Once the nasal structures have been exposed, the planned changes are applied in sequence:

Correction of the nasal bridge:

If there is a hump (bridge), the excess bone and cartilage are removed with a rasp or chisel. In the more precise 'component' technique, the cartilage layers are separated to allow for more controlled correction. Sometimes, cartilage support pieces ('spacer grafts') are placed to prevent the nasal midline from collapsing inward and to ease breathing.

Preparation of the nasal septum and support material:

The nasal septum deviation, which obstructs breathing, is corrected. At the same time, cartilage pieces to be used to support the tip of the nose are taken from here or, if necessary, from the ear/rib. During this procedure, sufficient supporting cartilage is left to prevent the nose from collapsing.

Shaping the tip of the nose:

The tip of the nose is the most important part of the operation. Small pieces are removed from the edges of the cartilages at the tip of the nose (caudal trim) to thin them. Then, support rods (columellar struts) are made from the harvested cartilage to keep the tip of the nose upright and maintain its shape permanently. The cartilages are joined together with special sutures to give the desired shape.

Narrowing of the bones:

After the hump is removed, a controlled fracture (osteotomy) is performed to narrow the remaining bones by joining them together or to narrow bones that are already wide. This can also be performed through a small incision in the skin.

Closure and final adjustments

Closing the incision:

The opened skin is closed again with aesthetic and fine sutures. The incision in the section separating the nostrils is carefully sutured so that it becomes almost imperceptible after healing.

Narrowing the nostrils:

If the nostrils are too wide, a small piece is removed from the base of the nostril in the final stage to narrow them.

Cast and bandage:

Special bandages and a cast (splint) are placed over the nose to maintain its new shape and reduce swelling.

Advantages and disadvantages of open rhinoplasty

Advantages:

The surgeon can directly see and touch the internal structures of the nose (cartilage, bones) with their eyes and hands. This allows for more precise and controlled work. It can be thought of as opening the back cover of a watch and seeing all the gears. It is the most effective method, particularly in the following challenging situations:

• Correction of a previously damaged nasal structure.
• Severely crooked, excessively large, or asymmetrical nasal tips.
• Congenital deformities (e.g., cleft lip-nose deformity).
• Nasal deformities following severe trauma.

Disadvantages of open rhinoplasty:

• A small scar remains on the thin piece of skin connecting the nostrils (columella). However, when sutured by a skilled surgeon, this scar is usually so faint that it is not noticeable unless looked at closely after healing.
• Lifting the entire skin of the nose can cause more and longer-lasting swelling, especially at the tip of the nose. The final, refined shape of the nasal tip may take longer to emerge compared to the closed technique (sometimes up to 1-2 years).
• For the same reason (removal of the skin), there may be a temporary feeling of numbness in the tip of the nose and surrounding area. This improves over time as the nerves heal.
• As it is a more technically complex procedure, the operation time is generally slightly longer than the closed method

Open rhinoplasty recovery process

Recovery after rhinoplasty is a gradual process that requires patience. It can take months, or even 1-2 years for the fine details, for your nose to take its final shape.

The first 2 weeks

• The operation is usually performed under general anesthesia. You may go home a few hours after the operation or the next day.
• A plaster cast (splint) and tape will be placed over your nose to maintain its new shape and reduce swelling.
• Thin tampons may be placed inside your nostrils in the first few days to help you breathe; these are removed shortly afterwards.
• You should lie on your back and keep your head elevated with 2-3 pillows. This helps reduce swelling.
• Swelling and bruising around your eyes will peak in the first 2-3 days. Cold compresses are very helpful for this.
• Pain is usually mild and easily managed with the painkillers provided. The main discomfort comes from nasal congestion, similar to a cold.
• At your weekly check-up (5-10 days), the plaster cast and stitches on your nose will be removed. Your nose will still be swollen when the plaster cast is removed; this is normal.
• Your nasal congestion may continue.
• You may begin light social activities (such as returning to the office/work) after this period.

1. Month - 6. Month

70-80% of the swelling disappears within the first month. Bruising around the eyes usually disappears completely.

• The tip of the nose may still feel swollen and firm.
• In the first few weeks, your nose may appear more upturned than expected; this will improve as the swelling subsides.
• Numbness at the tip is normal and will gradually subside over several months.
• If possible, wear contact lenses for the first 2-3 months to avoid putting pressure on your nose. If you must wear glasses, they should be very light or secured with a headband.
• Light walking can be started from the second week onwards. Avoid strenuous exercise, heavy lifting, and contact sports (football, basketball) for at least 1.5-2 months.
• You should not blow your nose for 3-4 weeks.

6. Month - 2. Year:

• Approximately 90% of your nose will take shape within 6 months. However, it may take 1 to 2 years for the final swelling, especially at the tip of the nose, to subside and for the nose to fully 'settle.'
• This process may take longer in people with thick skin.
• Your nose is very sensitive to the sun. Using high-factor sunscreen and a hat for at least 6 months, preferably 1 year, is very important to prevent scarring and support healing.
• Tissue healing is sometimes completely unpredictable. Very rarely, minor irregularities may occur.
• Most minor issues resolve on their own over time. Therefore, it is necessary to wait at least 1 year before considering a possible revision.

Who are suitable candidates for open rhinoplasty?

Related: Who are suitable candidates for rhinoplasty?

Those undergoing revision (second or third) surgery

Those with noticeable deformities at the tip of the nose

Those with congenital (present from birth) nasal deformities

Those who have suffered severe nasal trauma

Those seeking very large and extensive changes to their nose

Open rhinoplasty or closed rhinoplasty: what options are best for me?

• If you require a significant or complex change to your nose, have a structural support issue, or are undergoing a second operation, open rhinoplasty may be suitable.
• If you are having surgery for the first time and only require a limited, minimal change to your nose, closed rhinoplasty may be suitable.
• The most accurate decision is made following a detailed consultation with your experienced surgeon, who will assess your nasal structure and needs.

Open vs. closed rhinoplasty: what's the difference?

The fundamental difference between open and closed rhinoplasty is the incision method the surgeon uses to access the nose.

In closed rhinoplasty, all incisions are made inside the nostrils, leaving no external scarring. As there is less tissue trauma, recovery is generally faster, making it ideal for minimal changes. In open rhinoplasty, an incision is made in addition to the columella (the skin connecting the nostrils), and the nasal skin is completely lifted; this gives the surgeon a direct view of the nasal structures and allows for more extensive intervention, making it preferable for complex cases and revision surgeries. However, the recovery process may be longer, and a small scar that is not very noticeable externally may remain.

FAQs

Does open rhinoplasty leave scars?

You need not worry about the scar from open rhinoplasty. An experienced surgeon will use techniques to minimize this scar, and the natural and beautiful nose shape achieved more than justifies this very small and hidden scar. The scar from open rhinoplasty is not noticeable unless looked at closely or pointed out. The scar is invisible when viewed from a normal conversational distance.

Is closed rhinoplasty safer?

The main factor determining safety is the surgeon's preference, experience, and area of expertise rather than the technique itself.

When the right technique is applied by the right surgeon for the right patient, both methods are safe. The safest option for you is to consult an experienced plastic surgeon who will assess your nose structure and needs and recommend the most suitable technique for you.

Do closed rhinoplasty heal faster?

If your priority is a quick recovery and seeing the final result sooner, closed rhinoplasty offers an advantage in this regard. However, remember that the suitability of any technique depends on the structure of your nose and the complexity of the desired change. Your experienced surgeon will determine the best option for you.

Is closed rhinoplasty more natural?

No, closed rhinoplasty does not technically mean more 'natural' results. Naturalness depends more on the surgeon's approach, skill, and aesthetic understanding than on the technique used. It is important to choose a surgeon whose aesthetic understanding and natural results you trust.

How long does open rhinoplasty take?

• A simple procedure: If only the bone hump is to be removed and minor adjustments to the tip of the nose are to be made, the procedure may take around 1.5 to 2 hours.
• A complex/revision procedure: If the structure of the nose needs to be completely rebuilt, cartilage grafts (supports) need to be used, or a previous operation needs to be corrected (revision), the procedure may take more than 3 hours.

Can closed rhinoplasty make nose smaller?

Closed rhinoplasty is an ideal method for moderate reduction and refinement. It can significantly reduce the nose both in profile (removal of the hump) and in front view (narrowing of the bones, refinement of the tip).

For more information, feel free to contact us!