Open vs Closed Rhinoplasty: Which Technique & Why

개방형 대 폐쇄형 코 성형 (gaebanyeong dae pyejwayeong ko seonghyeong — open vs closed nose surgery) describes the two foundational surgical approaches to rhinoplasty. The choice between them determines how much structural access a surgeon has during the procedure and, in the open approach, leaves a small external scar. Both techniques are performed by 대한성형외과학회 (Daehan Seonghyeong Oegwa Haghoe — the Korean Society of Plastic and Reconstructive Surgeons, KSPRS), which is South Korea’s official certification board for plastic surgeons.¹ Understanding the difference helps you evaluate your surgeon’s proposed plan before committing to treatment.

Open Rhinoplasty: What It Involves and When It Is Preferred

Open rhinoplasty — also called external rhinoplasty — begins with a transcolumellar incision: a small zigzag or inverted-V cut made across the underside of the columella (the narrow strip of skin separating the two nostrils). This external cut connects to bilateral marginal incisions placed just inside the nostrils. Together, these incisions allow the surgeon to elevate the nasal skin envelope upward, exposing the underlying cartilaginous and bony framework in direct view.

That direct visualisation is the defining advantage of the open approach. With unobstructed sight lines, the surgeon can assess asymmetries, position grafts with precision, and place sutures under controlled conditions — rather than working blind through narrow internal access.

This access is specifically required when the procedure involves:

• Graft placement — septal cartilage, ear (auricular) cartilage, or rib cartilage grafts used to augment, support, or reshape the tip and dorsum
• Structural tip refinement — suture techniques or cartilage reshaping that require accurate three-dimensional assessment of the lower lateral cartilages
• Hump reduction with osteotomy — controlled bone cuts (osteotomies) to narrow the nasal bridge after dorsal reduction
• Significant dorsal augmentation — particularly common in Korean rhinoplasty, where augmenting a low dorsal profile with implant or rib cartilage is a frequent goal
• Revision rhinoplasty — where scar tissue and altered anatomy demand maximum visualisation

For these indications — which represent the majority of rhinoplasty procedures performed in Korea — open technique is the standard of care among KSPRS-certified specialists.¹

Closed Rhinoplasty: What It Involves and When It Is Preferred

Closed rhinoplasty — also called endonasal rhinoplasty — uses incisions placed entirely within the nostrils. Two main incision patterns are used: the intercartilaginous incision (between the upper and lower lateral cartilages) and the infracartilaginous incision (along the lower edge of the lower lateral cartilage, just inside the rim). No cut crosses the columella; the skin is never fully elevated as an envelope.

The genuine advantages of closed rhinoplasty are:

• No external scar — the columella remains uncut
• Slightly reduced post-operative swelling in some patients, because the nasal skin is not completely de-gloved from the underlying framework
• Shorter operative time for appropriate, limited cases

The critical limitation is restricted access. Working through narrow nostril openings without lifting the skin envelope means the surgeon cannot simultaneously view both sides of the nasal tip cartilages, cannot place cartilage grafts with the same precision, and cannot make symmetric suture adjustments under direct vision. This makes closed technique inappropriate for graft-dependent cases or complex structural corrections.

Closed rhinoplasty is well-suited to:

• Minor dorsal rasping (smoothing a small irregularity without cartilage removal)
• Minimal tip refinement where no graft placement is required
• Selected secondary procedures where the operating surgeon has prior knowledge of the patient’s anatomy and is making a single, targeted adjustment

Choosing closed technique for a procedure that actually requires structural access does not eliminate the complexity — it only reduces the surgeon’s ability to manage it accurately.

The Scar Question: Is the Columellar Scar Visible?

The transcolumellar scar is the most common concern patients raise when open rhinoplasty is proposed. The direct answer: placed correctly, it becomes difficult to detect at 12 months in most patients.

Scar placement matters. An incision made at the mid-columellar crease — the natural horizontal line crossing the columella midpoint — or at the soft-triangle junction follows existing skin topography and heals with less visible distortion than an incision placed arbitrarily. The scar sits on the underside of the nose: it is not visible in a straight-on photograph and is not prominent in a three-quarter view at 12 months in the majority of cases.

Factors that influence final scar quality include:

• Incision technique: a precise, clean cut minimises wound edge trauma
• Suture material and closure: fine, absorbable or removable sutures placed without tension
• Skin phototype: lighter skin types generally scar with less visible pigmentation
• Post-operative care: consistent sun protection (SPF 50+) during the first 6–12 months, and silicone scar gel applied from approximately weeks 4–8 of healing

At three months, the scar is visible — pink, slightly raised in some patients. By 9–12 months, it has typically flattened and faded. It is not a clinically meaningful reason to choose closed technique when structural work is planned.

What to Ask Your Surgeon

Three questions establish whether your surgeon has genuinely evaluated your anatomy and has a defensible technique rationale:

1. Which approach do you plan for my case, and what is the specific reason? A clear answer identifies the planned technique and ties it to your anatomy — for example, “open approach because you need a septal cartilage graft for tip projection.” A vague answer (“that’s just how we do it”) warrants follow-up.

2. Will graft material be required — and if so, from where? Graft use (septal cartilage, ear cartilage, rib cartilage) is nearly always an indicator for open technique. If your surgeon plans grafts, confirm that the proposed approach provides adequate access for precise placement.

3. Have you reviewed my anatomy in enough detail to determine this before surgery? Pre-operative assessment should include physical examination and, for complex cases, imaging or detailed photographic analysis. A surgeon who cannot describe what they observed about your nasal structure before committing to a technique has not completed adequate pre-operative planning.

KSPRS board certification is a legal requirement to perform rhinoplasty in Korea.¹ Verifying your surgeon’s certification is available directly on the KSPRS public registry before your consultation.¹

Korean Surgeon Preferences and Context

Korea’s rhinoplasty volume is among the highest per capita globally, and KSPRS-certified rhinoplasty specialists perform the open approach as the predominant technique for any case involving structural modification.¹ This reflects both the complexity profile of cases seen in Korean practice — where dorsal augmentation, tip refinement with grafts, and structural correction are routine requests — and the training depth required for KSPRS board certification, which encompasses a four-year plastic surgery residency following medical school.¹

The growing adoption of preservation rhinoplasty — an advanced technique that retains rather than excises nasal structural components — has further reinforced open technique prevalence in Korea, as complex preservation cases require the same direct visualisation that open access provides.

Sources

¹ Korean Society of Plastic and Reconstructive Surgeons — Board Certification Registry. [ksprs-registry-org-identity], [ksprs-registry-training-requirements], [ksprs-registry-total-certified], [ksprs-registry-public-verification], [ksprs-registry-legal-requirement]. Available at: https://www.plasticsurgery.or.kr/