In the open technique the surgeon adds a small incision in the columella — the bridge of skin between the nostrils — to the incisions inside the nose. This allows the skin of the tip to be lifted so that the bony and cartilaginous skeleton can be worked on under direct vision.
The price of that choice is a small external scar; what it buys is visibility. This page explains when the gain is worth the price. For the general framework, see the rhinoplasty page.
What is the open technique?
In external (open) rhinoplasty the skin covering the tip is separated completely from the cartilage beneath and lifted. The surgeon can see the true position of the lower cartilages, their asymmetries and their relationship to one another.
| Feature | Open technique |
|---|---|
| Incisions | Inside the nose + stepped or inverted-V columellar incision |
| Tip skin | Lifted |
| View | Direct, allowing two-handed work |
| Assessing symmetry | Can be compared side by side during surgery |
| Graft placement | Controlled, secured with sutures |
When is it preferred?
The open technique comes to the fore as the complexity of the work increases:
- Marked tip asymmetry — differences in cartilage length and angle need to be seen directly
- Deviated (fractured or S-shaped) noses
- Extensive graft requirements — supports prepared from septal, ear or rib cartilage
- Nasal valve collapse — placing grafts that open the airway
- Revision cases — noses with adherent tissue and altered anatomy
- Congenital nasal deformities such as cleft lip and palate
A recent review of graft materials and techniques in rhinoplasty stresses that correct positioning of supporting grafts is decisive for both aesthetic and breathing outcomes. That positioning can be carried out more reliably under direct vision.
The columellar incision and its scar
This incision is the only visible price of the open technique. What determines how noticeable the scar becomes:
| Factor | Effect |
|---|---|
| Incision design | A stepped or inverted-V incision is less noticeable than a straight one |
| Closure tension | Tension-free closure improves scar quality |
| Timing of suture removal | Delayed removal can leave suture marks |
| Sun protection | An unprotected scar can darken in the first months |
| Individual scarring tendency | A history of keloid or hypertrophic scarring increases risk |
The scar is pinkish and noticeable in the first weeks and fades over months. Maturation generally takes 6–12 months.
How is the operation performed?
Open rhinoplasty is carried out under general anaesthesia and takes 2.5–3.5 hours on average. It can take longer where grafts are needed or where there has been previous surgery.
- Making the columellar and internal incisions
- Lifting the tip skin — the cartilage framework becomes directly visible
- Assessing the septum — deviation corrected, cartilage harvested for grafts if needed
- Dorsal adjustment — hump reduction or lowering by a preservation method
- Osteotomies — repositioning the nasal bones
- Shaping the tip — suture techniques and supporting grafts
- Replacing the skin and closing
- Splinting
Open and closed: a comparison
A recent systematic review and meta-analysis reports that the two techniques are broadly similar on patient-reported outcome measures. In other words there is no single answer to "which is better"; the question should be "which one for this nose".
| Measure | Open | Closed |
|---|---|---|
| Field of view | Wide | Limited |
| External scar | Present (small) | None |
| Duration of tip swelling | Longer | Shorter |
| Control in complex cases | High | Limited |
| Operating time | Longer | Shorter |
| Graft placement | Straightforward | Difficult |
You can also look at the closed technique page to weigh the two approaches side by side.
Recovery
| Period | What to expect |
|---|---|
| First 2 days | Blockage, swelling and bruising around the eyes |
| Days 6–7 | Splint and columellar sutures removed |
| Week 2 | Bruising largely resolved |
| Months 1–3 | Marked reduction in swelling, the scar begins to fade |
| Months 6–12 | The tip refines, the scar matures |
| Months 12–18 | The result completes in patients with thicker skin |
During this period:
- The columellar scar is protected from the sun and cared for as advised.
- Pressure on the tip is avoided.
- Heavy exercise is postponed for the first 3–4 weeks.
- Nasal cleaning is maintained.
What are the risks?
In addition to the general risks of rhinoplasty, the open technique carries:
- A columellar scar healing more visibly than expected
- Longer-lasting swelling at the tip
- Temporary altered sensation at the tip
- Problems with the blood supply of the tip skin (uncommon)
The general risks are bleeding, infection, asymmetric healing, persistent breathing difficulty and the need for revision. This list is not exhaustive; risks specific to you are discussed separately during examination and the informed consent process.
