Written and medically reviewed by Dr Nizar Hamadeh, MD, MSc (Plastic Surgery), Consultant Plastic Surgeon on the GMC Specialist Register for Plastic Surgery. GMC number 7009480. Last reviewed: 4 October 2026.
If you are planning nose surgery, you will soon hear two terms: open and closed. You may have read that one leaves an obvious scar and the other is always gentler. Neither claim holds up. Below, I compare open vs closed rhinoplasty on the points patients ask me about most at consultation: the scar, recovery, risks and how the approach is chosen. For an overview of the operation itself, see my page on rhinoplasty in the UK.
What is the difference between open and closed rhinoplasty?
The difference between open and closed rhinoplasty is where the incisions go. In open (external) rhinoplasty, the surgeon makes incisions inside the nostrils plus one small cut across the columella, the narrow strip of skin between the nostrils, then lifts the nasal skin to see the structure underneath. In closed (endonasal) rhinoplasty, every incision stays inside the nostrils, so there is no visible scar, but the surgeon works with a narrower view.
Both approaches can reshape the bridge, the nasal bones, the tip and the nostrils. What changes is how much of the nose the surgeon can see and reach during the operation.
How does open rhinoplasty work?
Lifting the skin over the tip gives the surgeon a direct view of the cartilage and bone that shape the nose. Each part can be measured and adjusted precisely, and grafts that add structural support can be placed and stitched exactly where they are needed. That direct view is why the open approach is the usual choice for more complex work.
It is well suited to:
- Detailed reshaping of the nasal tip
- Noses that need cartilage grafts for support
- Crooked or twisted noses
- Revision surgery, where earlier changes make the anatomy harder to predict
- Breathing problems that need grafts, such as some types of nasal valve collapse
How does closed rhinoplasty work?
In closed rhinoplasty, the surgeon reshapes the nose through incisions inside the nostrils, without lifting the skin of the tip. Nothing shows on the outside, and for some patients the early swelling settles a little faster.
It is generally used for more limited changes, such as:
- Reducing a hump on the bridge
- Small refinements that do not need major tip work or grafts
Because the view is narrower, results depend heavily on the surgeon’s experience with closed work.
What are the pros and cons of closed rhinoplasty?
Closed rhinoplasty, sometimes marketed as “scarless rhinoplasty”, avoids any external scar, but it gives the surgeon a narrower view, so it suits some noses better than others.
| Pros | Cons |
|---|---|
| No visible scar on the outside | More limited view of the cartilage and bone |
| Fewer incisions | Harder to place and stitch grafts precisely |
| Often less swelling around the tip in the early weeks | Less suited to detailed tip work, crooked noses and most revisions |
The NHS guide to nose reshaping makes the same point: a closed operation avoids visible scarring, but is not always possible.
Where does preservation rhinoplasty fit in?
Preservation rhinoplasty is a newer way of lowering a hump. Instead of removing the bony and cartilage roof of the bridge, the surgeon keeps it intact and lowers it as a unit, which can help keep a smooth, natural bridge line. It describes what is done to the bridge rather than how the surgeon gets in, so it can be performed closed or open depending on whether the tip also needs work. Read more about preservation rhinoplasty.
Open vs closed rhinoplasty at a glance
| Open approach | Closed approach | |
|---|---|---|
| Incisions | Inside the nostrils plus one small cut across the columella | Inside the nostrils only |
| Visible scar | A small scar under the tip that usually fades to a fine line | None on the outside |
| Surgeon’s view | Direct view of cartilage and bone | More limited view |
| Typical uses | Tip work, grafts, crooked noses, revision surgery | Hump reduction, smaller refinements |
| Early swelling | Often more around the tip | Often less |
Does open rhinoplasty leave a visible scar?
Open rhinoplasty leaves a small scar across the columella, under the tip of the nose. Surgeons usually cut it in a stepped or inverted-V shape rather than a straight line, because an irregular line tends to heal less noticeably. For most people it fades to a fine line that is hard to see without looking from below.
A study in the journal Aesthetic Plastic Surgery asked 91 patients who had open surgery whether they were aware of their columellar scar, and 12 said they were. The scar is still the main drawback of the open approach, so it is a fair question to raise at your consultation. You can see healed results in my before-and-after gallery.
How do results differ between open and closed rhinoplasty?
When each approach is used for the right nose, both can give natural, lasting results. The incision is only the way in; the result depends mainly on your anatomy and the surgeon’s planning. The open view gives more precise control for complex changes such as tip reshaping and grafts, while the closed route avoids an external scar for simpler changes.
Is recovery different in open vs closed rhinoplasty?
The broad pattern is the same with both approaches. The first one to two weeks are the most noticeable, with swelling, bruising and a blocked feeling in the nose, and most people take about two weeks off work. The nose then keeps refining over the following months.
The main difference is at the tip. Because the skin of the tip is lifted in open surgery, tip swelling usually takes longer to settle and can take a year or more to fully refine, particularly in thicker skin. My guide to rhinoplasty swelling stages walks through the timeline week by week.
What are the risks of rhinoplasty?
The risks depend more on how much is changed than on the incision approach. According to the NHS, it is common after nose reshaping to have swelling, bruising, a blocked nose and a nose that feels stiff and numb for a while.
Less commonly, rhinoplasty can lead to:
- Breathing difficulty through the nose
- Nosebleeds
- Asymmetry or a result that does not match what you hoped for
- A change in sense of smell
- A hole in the septum (septal perforation)
- The need for further surgery
Some patients go on to have a revision operation. At your consultation I will go through the risks that apply to your nose specifically, alongside the general risks of anaesthesia.
What type of anaesthesia is used for open vs closed rhinoplasty?
The type of anaesthesia depends on how extensive the surgery is, not on the incision approach. The NHS notes that nose reshaping is usually carried out under general anaesthetic, so you are asleep. Smaller operations can sometimes be done under local anaesthetic, where the nose is numbed. Your surgeon and anaesthetist will explain which option is planned for you.
Open vs closed rhinoplasty: which is better?
Neither approach is better for everyone. The right approach depends on what your nose needs, and skin thickness plays a part too: thicker nasal skin can hide fine detail, so a nose with thick skin often needs stronger internal support for the new shape to show. A small hump reduction may not need direct vision at all, while a detailed tip change or a rebuild with grafts usually does.
For breathing problems, a deviated septum can often be straightened alongside cosmetic changes with either approach (a septorhinoplasty), while repairs that need grafts are usually easier with direct vision.
Most revision rhinoplasty is done open, because scar tissue and earlier changes make the anatomy harder to predict. A small, limited correction can sometimes still be done closed.
Can you choose between open and closed surgery?
Yes, you can tell your surgeon your preference, and it should be part of the conversation. The final plan, though, needs to fit your anatomy and what you want to change. A good surgeon will examine you in person, explain which approach they recommend and why, and leave you room to weigh that against your own priorities.
Useful questions to ask:
- Which approach do you recommend for my nose, and why?
- What exactly will you change, and could it be done closed?
- If there will be an external cut, where will the scar be and how does it usually heal?
- How will the approach affect my swelling and recovery time?
- How many rhinoplasties do you perform each year, and how many are revisions?
What affects the cost?
The cost of rhinoplasty depends mainly on how much needs to change, whether grafts are needed, whether breathing is corrected at the same time and whether it is a first or a revision operation. The incision approach itself is rarely the deciding factor. Your personalised quote is given after your consultation.
Frequently asked questions
How long does an open rhinoplasty scar take to fade?
The scar across the columella is usually pink at first and fades gradually over the following months. For most people it settles into a fine line within about a year.
Is closed rhinoplasty less painful than open rhinoplasty?
Discomfort is usually similar with both approaches. Most people describe pressure and a blocked feeling, like a heavy cold, rather than sharp pain, and it is usually well controlled with simple painkillers.
Can the nasal tip be changed with closed rhinoplasty?
Small tip refinements can sometimes be done closed. Detailed tip reshaping, and any work that needs grafts stitched precisely in place, is usually easier and more predictable with the open approach.
Is piezo rhinoplasty open or closed?
Piezo rhinoplasty uses an ultrasonic instrument to reshape the nasal bones. Because the instrument needs a clear view of the bone, it is usually performed with the open approach. Read more about piezo rhinoplasty.
Considering rhinoplasty?
If you are weighing up open and closed rhinoplasty, the most useful next step is an examination. At 10 Harley Street I assess your nose, explain which approach I would recommend and why, and follow the Royal College of Surgeons’ two-stage consent process, with a cooling-off period before any decision to go ahead. You can start with an initial call, but surgery is only ever planned after an in-person examination. I operate at The Fitzrovia Hospital, the Cadogan Clinic and HHV.
About the author
Dr Nizar Hamadeh is a Consultant Plastic Surgeon on the GMC Specialist Register for Plastic Surgery (GMC 7009480), seeing patients at 10 Harley Street, London. He qualified in medicine in 1997, trained in otolaryngology and head and neck surgery at university hospitals in Paris and Brussels, and holds an MSc in Plastic Surgery. His practice focuses on aesthetic and functional rhinoplasty, including septorhinoplasty and revision surgery, alongside facial rejuvenation. He operates at The Fitzrovia Hospital, the Cadogan Clinic and HHV. He was a finalist for Best Surgical Result at the Aesthetics Awards 2025. Read Dr Hamadeh’s full profile.
Sources
- NHS: Nose reshaping (rhinoplasty)
- BAPRAS: Rhinoplasty patient information
- Royal College of Surgeons: Professional Standards for Cosmetic Surgery
Medical disclaimer
This article is for general information only and does not replace a personal consultation with a qualified doctor. Every nose is different and results vary. If you have concerns about your nose or your breathing, speak to your GP or a qualified specialist.