Rhinoplasty, commonly referred to as a nose job, is a surgical procedure designed to alter the size, shape, and overall appearance of the nose to achieve greater facial harmony. It can also correct structural issues that impede proper breathing. Surgical approaches are categorized into two types: open or closed. Closed rhinoplasty is a specific technique where the entire operation is performed without making any external incisions. This endonasal method is popular for patients seeking refinement while avoiding a visible scar.
Understanding Closed Rhinoplasty
Closed rhinoplasty is defined by placing all surgical incisions entirely inside the nostrils, within the nasal mucosa. Because the incisions are hidden, this technique is often referred to as a “scarless nose” procedure. The primary advantage is the elimination of any external evidence of surgery, which appeals to patients concerned about post-operative visibility.
This method is best suited for patients requiring less extensive modifications to their nasal structure. Ideal candidates seek to correct issues such as a dorsal hump on the bridge of the nose, or to refine the nasal tip in a less complex manner. Patients undergoing a first-time rhinoplasty with favorable nasal anatomy for internal access are typically the most appropriate candidates. Conversely, individuals needing significant structural changes or major reshaping of the nasal tip often require the enhanced access of the alternative technique.
The Surgical Technique
The procedure begins with the administration of anesthesia, which may be general or local combined with intravenous sedation, depending on complexity and the surgeon’s preference. The surgeon then makes small, precise incisions within the lining of the nostrils, known as the endonasal approach. These internal incisions provide access to the underlying bone and cartilage framework.
Specialized surgical instruments are inserted through these narrow openings to manipulate and sculpt the nasal structures. For instance, a dorsal hump may be reduced by shaving down excess bone and cartilage, or the tip cartilage may be reshaped using sutures or by excising small amounts of tissue. The surgeon works through limited openings, relying on a three-dimensional understanding of the nasal anatomy rather than direct visualization. Once modifications are complete, the internal incisions are closed using dissolvable sutures. A splint or cast is then placed on the outside of the nose to protect and support the newly shaped structure during initial healing.
Closed Versus Open Rhinoplasty
The fundamental difference between the two techniques lies in the placement of surgical incisions. In closed rhinoplasty, all incisions are concealed inside the nostrils. The open technique requires an additional, small incision across the columella, the narrow strip of tissue separating the nostrils. This transcolumellar incision allows the surgeon to lift the nasal skin, offering a complete view of the underlying nasal framework.
The open approach provides direct visibility and greater control, making it the preferred method for complex cases, significant tip-reshaping, or revision surgeries. The trade-off for enhanced visibility is the potential for a small, visible external scar and more extensive tissue dissection, which leads to increased post-operative swelling. The closed technique causes less disruption to the nasal soft tissues and blood supply, resulting in less initial swelling and a shorter operative time. However, the limited visual field of the closed approach makes it less suitable for intricate structural work or major cartilage grafting.
Recovery and Post-Operative Care
Following closed rhinoplasty, patients typically have a splint or cast placed on the nose, usually removed about one week after the procedure. Initial bruising, which may extend around the eyes, and swelling are expected, often peaking around the third or fourth day post-surgery. Pain is manageable with prescribed medication and can be mitigated by keeping the head elevated, even while sleeping, to reduce fluid accumulation.
Most patients return to non-strenuous work or light activities within one to two weeks, once the external splint is removed and visible bruising has faded. Strenuous exercise, including heavy lifting, is restricted for three to four weeks to prevent complications and minimize swelling. While initial swelling resolves quickly, residual swelling, particularly in the nasal tip, can persist for many months. The final result typically becomes fully apparent only after six months to a full year, once all swelling has subsided.