Open rhinoplasty: aesthetics and function at your service

This is the first step of your 8 part journey into the exclusive guide on rhinoplasty types. 

There are different ways to perform rhinoplasty, and the majority of nose surgeries are carried out through an open rhinoplasty. But why? This is because open rhinoplasty provides the surgeon with better access to the internal structures of the nose, and the ability to address a wider range of aesthetic and functional concerns, including a crooked nose, a bump on the bridge, and breathing difficulties.

Open rhinoplasty is a great way to give your nose a new look and feel confident about your appearance! If you’re not happy with how your nose looks or works, this procedure can make a big difference. By reshaping your nose, you can achieve the look you’ve always wanted and feel better about yourself.

This article will explain what an open rhinoplasty is, how it works, the benefits and drawbacks involved, and other important points to consider.

Without further ado, let us begin.

What is an open rhinoplasty?

Open rhinoplasty is a type of nose surgery, a surgical approach able to give the doctor a better view of the inside of the nose. It’s also called external rhinoplasty or approach. This type of surgery involves making a small cut on the outside of the nose, usually between the nostrils, an area called the columella. This cut “opens” the frontal part of your nose and helps the doctor see what they’re doing and make the changes they need to improve the appearance or function of your nose. Whether you want to fix a cosmetic issue or a breathing problem, open rhinoplasty can help you get the results you’re looking for.

open rhinoplasty

How is open rhinoplasty performed?

Let us look deeply at what happens during the open rhinoplasty procedure. You may be curious to know more about the detail of every single step of the way. Many people claim to be less worried when they know everything about the procedure. We will give you a brief explanation of the open rhinoplasty process.

So, how does open rhinoplasty work?

The whole surgical device is sterilized before the operation to prevent any risks of infection. Depending on the surgeon’s decision, the operation is done under general or local anesthesia. The patient will not feel any pain or inconvenience during the operation. If you get local anesthesia, your eyes will be covered to avoid any scary view. 

Now, everything is ready for the operation to begin. The incision is not made in a straight line but in Z, V, or W patternsThis is to avoid visible scars. Along the columellar cuts, the surgeon also makes additional incisions within the nostril walls on the inside. With these incisions, the surgeon is able to open the frontal part and put the columellar skin (between your nostrils) and the soft tissue covering the cartilage and nasal bones aside and reach the nasal structures beneath.

The most common incisions are:

The stair-step incision:
This trans-columellar incision is favored by many surgeons as it leaves almost no trace of surgery. Other names for this incision are the staircase pattern or the Z pattern. 
However, surgeons do not recommend this pattern for Asian rhinoplasty patients. Due to their unique nasal features, there is an increased chance of conspicuous scars and deformities.

The inverted V incision:
This is a common trans-columellar incision as it decreases the risk of visible scars. However, if the incision closure is not subtle, it can lead to an unpleasant appearance.

Columellar V incision:
The incision is made on mid columellar or lower columellar. This is a frequent pattern used to address deformities such as cleft lip nose deformity. 

Depending on the patient’s goals and wishes, the surgeon will reshape the bones, cartilage, and/or soft tissues to create the desired shape and function.

Once the surgery is over, the doctor stitches the columella (between the nostrils) with a very subtle and thin suture and then will put the nasal cast and nasal packing. Usually, this surgical wound heals perfectly. It will be hardly detectable once the healing period is completed.

How long does it usually take?

The average time of surgery with the open rhinoplasty approach is 1.5 to 3 hours. It can take longer in complicated cases, where the nasal structure requires a lot of modification. 

Previously, the open technique used to take longer, as the suturing would be time-consuming. Nowadays, due to improvements in techniques and more experienced surgeons, the length of the surgery has significantly decreased. Also, the accessibility to the inner structures provided by the open approach can actually reduce the operation duration.

What does an open nose surgery change?

We would like to remind you that rhinoplasty surgical planning is customized for each individual. The type and amount of changes each patient receives are based on their unique facial features and aesthetic goals. For people who need more surgical correction, such as nasal tip refinement techniques, open rhinoplasty is the technique of choice. In functional nose surgeries, like septoplasty to address a deviated nasal septum, surgeons go on with an open rhinoplasty.

In general, changes through an open rhinoplasty approach are:

  • Reshape the bridge:
    The size and shape of the nostrils can be modified to balance the overall appearance of the face;
  • Change in the shape or size of your nose: 
    The size and shape of the nostrils can be modified to balance the overall appearance of the face;
  • Refine the tip: 
    The tip of the nose can be made more refined and lifted for a more aesthetically pleasing appearance;
  • Improve breathing: 
    Removes obstructions in the nasal passages and modifies the shape of the septum and/or turbinates.
  • Modifications in the nasal angle:
    The angle can be altered by modifying the nasal bridge, the nostrils, and the nasal tip;
  • Correct asymmetry: 
    If the nose is asymmetrical, it can correct this imbalance;

For less vast procedures that require less change, like a hump reduction without tip refinement, surgeons may use the closed approach

Pros and cons of open rhinoplasty

For a better nasal appearance, choosing the correct surgical approach is crucial. Knowing the advantages and this advantages of the surgical procedure helps patients choose wisely and to set more realistic expectations. Here, we have listed the pros and cons of the external approach.

Pros of  open rhinoplastyCons of open rhinoplasty

Visibility of the nasal structures

The possibility of increased swelling

Direct access to the internal structures of the nose

Longer surgery duration

Providing more strength and stability

External scars

Educational Value

Weak nasal frameworks

The benefits of an open rhinoplasty

The advantages of the open approach in both functional and aesthetic rhinoplasty, make it a common practice among nose surgeons. Let’s take a look at these advantages:

Visibility of the nasal structures

The open rhinoplasty approach gives the ability to see the nasal bone and cartilage. The better the doctor can see under the skin surface, the more accurately they can see the nasal deformities. And this leads to a better nose shape.

Direct access to the internal structures of the nose

In addition to the direct vision of the nasal anatomy, another great benefit of open rhinoplasty is maximum exposure to the internal nasal structures. This accessibility helps the surgeon apply the best rhinoplasty techniques, They can correct the deformities in a more subtle and precise way. 

Providing more strength and stability

When the nose surgeon has full visibility of the structures of the nose, they provide more support for the nasal framework. This results in more stability of nasal structures and a better nasal shape.

Educational Value

This is a great advantage for doctors and students who like to have an in-depth learning experience. This detailed understanding of nasal anatomy is an enormous privilege for future nose surgeons.

More experienced surgeons can sharpen their skills, and this will indirectly work in favor of patients. They get to choose from more well-trained surgeons.

The negatives you need to know about

All surgeries have their own disadvantages, and the open rhinoplasty approach is no exception. The disadvantages of this challenging procedure are as followed:

The possibility of increased swelling

Undeniably, open rhinoplasty is a challenging and invasive rhinoplasty approach. In open rhinoplasty, the skin is cut and elevated. This can result in more swelling and bruising. Yet, this edema will subside shortly after. If the patient follows all the post-op instructions, the recovery times won’t be much of a problem. 

Longer surgery duration

The longer the procedure, the more the chances of bruising and edema. Interestingly, some surgeons claim open surgery can be faster due to the vast visibility and accessibility it provides. That’s why it is important to choose the right nose surgeon for your cosmetic procedures.  

External scars

One negative point of the open approach is the possibility of a remaining surgical scar on the columellar skin. Through the right incision and suturing techniques, the scar will not be much conspicuous. An expert rhinoplasty surgeon understands these aesthetic concerns. That’s why through the physical examination, the doctor will do a thorough analysis of the nasal skin. 

As surgical techniques improve, the scars are less likely to be perceptible. According to studies, in recent years about 90% of patients claim the external scars to be not or hardly visible. (1)

Weak nasal frameworks

One downside of open rhinoplasty is the possibility of losing structural stability. As a result, the nasal walls might collapse and revision nose surgery might be needed. Therefore, it is essential to consider a reliable surgeon with high success rates. 

Who can undergo open rhinoplasty?

The final decision on if a patient can get an open rhinoplasty highly depends on two factors: the patient’s preferences and surgical requirements. The surgeon decides if the patient is a candidate for the open approach. A patient should have the following qualifications in order to be eligible for open rhinoplasty:

  • At least 16 years old for women and 18 for men;
  • In good general health;
  • Chronic conditions under control;
  • Realistic expectations on what you can and cannot achieve;
  • Major cosmetic concerns;
  • Major functional change needed;

People who require major changes in their nasal structure might be the ones to benefit the most from this surgical approach. Major changes such as nasal tip alteration or projection of the nose need direct access, therefore open rhinoplasty is the right approach. 

Chronic medical conditions such as diabetes or high blood pressure should be perfectly managed before the operation. Such conditions increase the possibility of scarring and prolonged recovery time.

External rhinoplasty enables the surgeon to make a lot of changes to create the ideal nose shape for your facial harmony. You should know sometimes not every requirement a patient has is not possible to fulfill. Sometimes the nose shape is in contrast with facial balance, and sometimes the nasal anatomy creates restrictions and limitations. Having practical expectations helps achieve the desired aesthetic appearance as well as prevent disappointment. 

How do I know if open rhinoplasty is good for me?

If you are curious to know if this surgical approach is appropriate for you, the best way to find out is to consult with your surgeon. A thorough facial analysis alongside a comprehensive nasal analysis is done to evaluate the necessary changes. 

Here are some factors that may determine if open rhinoplasty is good for you:

  • A desire to change the appearance of your nose, such as making it smaller or changing the shape of the tip
  • A deviated septum or other structural issues that are affecting your breathing
  • The presence of a bump on the nasal bridge
  • A nose that is too wide or too narrow

If you’re still not sure about the procedure, you can check out our article where we compare open and closed rhinoplasty techniques to help you with your decision.

What are the open rhinoplasty cost and fees you need to know about?

Undeniably, the cost of the surgery can impact the final decision. In recent years, many popular cosmetic surgery centers have offered world-class services at reasonable prices. On average, the price range of open rhinoplasty can vary greatly and ranges from 3,000 to 10,000$, but the final cost depends on several factors, including the location of the surgery, the surgeon’s expertise, the complexity of the operation, and any additional fees for:

  • Anesthesia
  • Pre-operative tests
  • Medications
  • Facility use
  • Post-operative care
  • Revision surgery or other medical treatments in case of any complications

It’s worth noting that in certain regions, the total price for open rhinoplasty may be inclusive of all expenses, whereas, in other regions, it may only account for the surgeon’s fee. If you’re looking for an affordable way to achieve the nose shape you desire, we will always be happy to answer any further questions you might have. 


(1) Raggio BS, Asaria J. Open Rhinoplasty. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Link

(2) Seyed EH, Hormoz M., Abdolreza R., Mohammad R. A., Massumeh N., Comparison between step incision and inverted v incision in columellar scar in open rhinoplasty, J Res Med Dent Sci, 2018, 6(6): 257-263 Link

(3) Ihvan O, Seneldir L, Naiboglu B, Verim A, Cetiner S. Comparative Columellar Scar Analysis Between W Incisions and Inverted-V Incision in Open Technique Nasal Surgery. Indian J Otolaryngol Head Neck Surg. 2018 Jun;70(2):231-234. doi: 10.1007/s12070-017-1096-3. Epub 2017 Feb 4. Link

(4) Verim A, Duymuş R, Çalim ÖF, Karaca ÇT, Özkul MH, Yasar H, Bahadir E, Bakal N. Effect of nose skin on the columellar incision scar in a Turkish population. Otolaryngol Head Neck Surg. 2013 Sep;149(3):438-44. doi: 10.1177/0194599813496961. Epub 2013 Jul 26. PMID: 23894145. Link

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