Open vs. Closed: Two Approaches to Rhinoplasty | Dr. Wayne Carman

Open vs. Closed: Two Approaches to Rhinoplasty

Nose surgery is a versatile procedure with many variations. The broad category of “nose reshaping” encompasses everything from reducing the width of overly wide nostrils to smoothing out a nasal hump to making any number of alterations intended to cause a nose to appear more in proportion with the rest of the face.

Since there are so many different possible variations, there are numerous techniques that may be employed by the surgeon. Of particular note are the two methods for creating incisions during rhinoplasty surgery. Toronto Plastic Surgeon Dr. Wayne Carman uses both the “closed” and “open” approaches, each in specific circumstances.

The closed approach is the most common. It involves the creation of small incisions hidden within the nose itself. Surgeons who use this method are experienced in using specialized tools that allow them to trim cartilage, smooth bone and suture tissues all through these small internal incisions. Benefits of the closed approach include a lack of potential visible scarring and no sutures that require removal at a later date. All internal sutures are designed to dissolve on their own.

The open approach is often reserved for alterations to an asymmetrical or overly wide nasal tip. This technique requires the creation of a small incision in the columella, which is the technical name for the partition between the nostrils. This incision allows the surgeon to literally open up the skin and expose the otherwise hidden structures, figuratively opening up a range of surgical techniques possible only with this method.

Both approaches can yield natural-looking results and a nose that better harmonizes with the rest of a patient’s facial features. The main difference is in the fact that the incisions required by an open rhinoplasty will be sutured closed again, resulting in a thin line on the columella. A plastic surgeon experienced in rhinoplasty, such as Dr. Carman, designs this approach to minimize and camouflage any scarring.

All rhinoplasty patients will wear a plaster splint after their procedure—whether closed or open—and will experience swelling and bruising for a short time. Plastic Surgeon Dr. Wayne Carman can describe more of the similarities and differences in the two approaches at a personalized consultation. Call (416) 322-7108 or 1-888-451-1140, or visit