Short answer
The difference is where the incisions go. In open rhinoplasty the surgeon adds a small cut across the columella (the strip of skin between the nostrils) and lifts the skin to see the framework directly; in closed rhinoplasty all incisions stay inside the nostrils, so there is no external scar.1 Neither approach has been shown to give better results overall. Which one is used depends mainly on how much tip or structural work is needed and on the surgeon’s training.4
Key points
- Open: one extra incision across the columella, plus incisions inside the nose.
- Closed: incisions inside the nostrils only, with no visible scar.
- Open surgery gives a clearer view of the tip; patient guides say it means more swelling, but a 2025 meta-analysis found no significant difference in swelling.
- A systematic review could not say that either approach leads to better looks or breathing.
- The surgeon’s experience with a technique usually matters more than the label.
How the two approaches differ
Both are ways of reaching the same structures: the nasal bones, the septum (the wall of cartilage and bone dividing the two sides of the nose) and the tip cartilages. The NHS describes the choice simply as either a cut across the skin between the nostrils, or tiny cuts inside the nostrils.1
In the open approach, the columella incision lets the surgeon fold the skin of the nose upwards, a bit like lifting a cover, and work on the cartilage under direct vision.23 In the closed (endonasal) approach, the surgeon works through the nostrils, seeing less at once but disturbing less of the surrounding tissue.
| Feature | Open rhinoplasty | Closed rhinoplasty |
|---|---|---|
| Incisions | Inside the nose plus a small cut across the columella | Inside the nostrils only |
| Visible scar | A fine line under the nose, usually faint once healed | None on the outside |
| Surgeon’s view | Direct view of the tip cartilages | More limited, relies on feel and partial views |
| Early swelling | Described as greater in patient guides2 | Described as less in patient guides2; a 2025 meta-analysis found no significant difference in swelling or bruising6 |
| Overall results | No clear difference shown in published comparisons | |
When each approach tends to be used
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) notes that the open approach gives the surgeon a better view when the tip is being changed.2 That is why it is often chosen when the tip needs reshaping, when grafts (small pieces of cartilage used to support or reshape the nose) are planned, or when earlier surgery has left scar tissue.
A closed approach may suit more limited changes, such as smoothing a bump on the bridge. The NHS points out that it leaves no visible scars but is not always possible or available.1 In practice, many surgeons train mainly in one approach, and the review authors listed this skill difference as a source of bias in comparing them.4
Does the approach change recovery?
Somewhat, but the basic recovery is similar. Either way, rhinoplasty is usually done under general anaesthetic, takes around 1.5 to 3 hours, and is followed by a splint taped over the nose for about a week.1 The NHS advises allowing up to two weeks off work and says swelling can take up to six months to settle fully.1
BAPRAS states that with open surgery the swelling will be greater and recovery longer, while closed surgery usually takes about two weeks to settle.2 One study included in the systematic review found less early swelling and bruising with the closed approach.4 However, a 2025 meta-analysis that pooled 12 studies (1,067 patients) found no significant difference between the approaches in swelling, bruising, operating time, satisfaction or complication rates.6 How much the bones are moved, and individual skin thickness, also strongly affect how long swelling lasts. For timelines, see how long swelling lasts after rhinoplasty.
What the evidence says
The evidence comparing the two approaches is Limited. A 2022 systematic review in Archives of Plastic Surgery included 20 studies, most of them retrospective (looking back at past patients) rather than randomised trials.4 Both approaches showed high satisfaction for patients and surgeons, and the authors concluded they could not say which leads to better functional or aesthetic outcomes.4
The review also noted a lack of standard outcome measures. It recommended scoring tools such as the NOSE scale (Nasal Obstruction Symptom Evaluation, a questionnaire on blocked breathing) for future studies.4 Until better trials exist, claims that one approach is clearly superior are not supported.
How noticeable is the open rhinoplasty scar?
For most people it is not a major concern, though it is a real scar. In a study of 91 people after open rhinoplasty, about one in eight mentioned the columella scar when asked about facial scars.5 Being aware of the scar was not linked to lower satisfaction with the operation, although it was linked to lower overall body satisfaction.5
This was a single study from one centre, so the findings may not apply to everyone. Healing varies with skin type and tendency to form raised scars, which is worth discussing beforehand.
Common questions
Is closed rhinoplasty safer?
Not clearly. The risks listed by the NHS, such as bleeding, infection, breathing difficulty, altered sense of smell and dissatisfaction with the shape, apply to rhinoplasty in general.1 In the systematic review, the small number of complications reported in the cosmetic studies all occurred after open surgery, but patient numbers were small and the authors could not conclude that either approach was better overall.4
Can both approaches fix breathing problems?
Yes, both can be used to straighten a deviated septum or support the airway. The American Society of Plastic Surgeons notes that a deviated septum can be straightened during rhinoplasty to improve breathing.3 More detail is in whether rhinoplasty can improve breathing.
Is open rhinoplasty only used for big changes?
No, but it is more common when the tip or internal support needs detailed work. Surgeons differ in their default approach, so it is reasonable to ask why a particular one is being suggested for your nose.
Does the approach affect the final shape?
Published comparisons have not shown that it does on average.4 The plan for the bones and cartilage, your skin thickness and how you heal are likely to matter more.
Bottom line
Open and closed rhinoplasty are two routes to the same structures, separated mainly by one small external incision. Open surgery trades a fine scar, and possibly more early swelling, for a clearer view; closed surgery avoids the scar but suits fewer situations. The better question to ask is why a surgeon recommends one route for your particular nose.
Related reading
- Rhinoplasty: what it involves, risks and recovery
- How Long Does Swelling Last After Rhinoplasty?
- What Is Preservation Rhinoplasty?
- Can Rhinoplasty Improve Breathing?
Sources
- NHS. Nose reshaping (rhinoplasty). NHS website. https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/nose-reshaping-rhinoplasty/ Accessed 5 November 2026.
- British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Rhinoplasty: patient information. BAPRAS. https://bapras.org.uk/public/patient-information/surgery-guides/rhinoplasty Accessed 5 November 2026.
- American Society of Plastic Surgeons. Rhinoplasty procedure steps. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/procedure Accessed 5 November 2026.
- Gupta R, John J, Ranganathan N, et al. Outcomes of Closed versus Open Rhinoplasty: A Systematic Review. Archives of Plastic Surgery; 2022;49(5):569–579. https://doi.org/10.1055/s-0042-1756315
- Yağmur Ç, Ak S, Engin MS, et al. Columellar Scar Perception in Open Rhinoplasty: Interplay of Scar Awareness, Body Cathexis and Patient Satisfaction. Aesthetic Plastic Surgery; 2017;41:153–160. https://doi.org/10.1007/s00266-016-0719-5
- Abi Zeid Daou C, Jalkh RM, Semaan ZM, Daou AM. Outcomes of open versus closed rhinoplasty, a systematic review and meta-analysis. Plastic and Reconstructive Surgery Global Open; 2025. https://doi.org/10.1097/GOX.0000000000007047
Article history
- — First published.