Open rhinoplasty and closed rhinoplasty are the two primary approaches to nose surgery, and the difference between them can be more than just where the surgeon places an incision. The approach your surgeon selects can effect the entire experience: how the procedure unfolds, how you recover, and what your long-term results look like.
Dr. Richard W. Westreich is a double board-certified facial plastic surgeon who has performed more than 4,000 facial surgeries over two decades of practice on the Upper East Side of Manhattan. His certification from the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) requires completion of an accredited fellowship in facial plastic surgery and Otolaryngology (ABO), demonstrating surgical competency in both, and passage of written and oral examinations for 2 separate Boards, setting it apart from general plastic surgery credentials. His parallel certification in Otolaryngology means he approaches the nose as both a cosmetic and a functional part of the body.
In this guide, Dr. Westreich explains the practical differences between open and closed rhinoplasty, which technique is best suited to each, and what patients can expect at every stage of their care.
What Is Open Rhinoplasty?
Open rhinoplasty is a surgical technique that involves an external incision placed across the columella, the narrow strip of tissue between the two nostrils. This incision allows the surgeon to lift the nasal skin and gain direct, unobstructed access to the underlying cartilage and bone.
The full anatomy of the nose is visible throughout the procedure, making open rhinoplasty well-suited for cases requiring extensive structural changes or complex repairs.
At New Face NY, Dr. Westreich reserves the open approach for cases where the specific technical aspects of the surgery exceed what can be addressed endonasally. For example:
- Significant revision rhinoplasty where prior surgical changes require direct visualization
- Septal fractures or deficiencies requiring more extensive reconstruction
- Cases done under local where only tip refinement is necessary
The columellar scar left by open rhinoplasty is small, positioned on the underside of the nose, and typically fades to near-imperceptibility within several months to a year.
What Is Closed Rhinoplasty?
Closed rhinoplasty, also called endonasal rhinoplasty, is performed entirely through incisions made inside the nostrils. Key characteristics of the approach include:
- No external incisions, which means no visible scarring on the surface of the nose.
- Full access to the nasal anatomy through the nostrils alone.
- The ability to modify cartilage and bone, place grafts, and apply sutures without an external opening.
Dr. Westreich uses closed rhinoplasty as his primary approach:
- His preference is grounded in extensive closed Rhinoplasty training and a large body of published outcomes
- This includes his development of the Foundation Rhinoplasty technique, a closed method designed specifically to straighten noses affected by septal deviation and facial asymmetry
- He has served as a course instructor for the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and has authored and co-authored over 20 peer-reviewed publications on rhinoplasty technique and nasal anatomy, mostly using closed techniques
Three clinical advantages drive his preference for the closed approach:
- Patients typically recover more quickly compared to open rhinoplasty
- The tip-profile relationship is easier to establish and predict through the endonasal view
- Preserving the blood supply to the nasal skin reduces the risk of long-term scarring or skin thinning over the nasal tip
Open vs. Closed Rhinoplasty: A Side-by-Side Comparison
| Feature | Open Rhinoplasty | Closed Rhinoplasty |
|---|---|---|
| Incision location | Across the columella (external) | Inside the nostrils only |
| External scarring | Small scar, typically fades significantly | None |
| Surgical visualization | Full, direct view of all structures | Complete access via nostrils |
| Recovery time | Slightly longer | Often faster |
| Tip swelling duration | May persist somewhat longer | Tends to resolve more quickly |
| Best suited for | Complex revisions, reconstruction, specific manuevers, such as a septal extension graft | Primary rhinoplasty, tip refinement, deviated septum, Foundation Rhinoplasty |
| Dr. Westreich's use | Specific technical indications and local only Rhinoplasty | Primary approach |
Who Is a Good Candidate for Each Approach?
According to the American Society of Plastic Surgeons, rhinoplasty remains one of the most frequently performed cosmetic procedures in the United States each year. As patient goals and anatomical presentations vary widely, the ability to work fluently with both approaches is what separates a specialist from a generalist.
Closed rhinoplasty is typically appropriate for:
- Primary (first-time) rhinoplasty patients and most Revision Rhinoplasty cases
- Cases focused on dorsal hump reduction, tip refinement, and septal correction
- Patients with good skin elasticity and blood supply
- Patients who want to minimize recovery time
Open rhinoplasty may be recommended for:
- Selected patients undergoing revision rhinoplasty after a previous procedure
- Cases requiring Septal Extension Grafting
- Reconstructive septal fracture cases
- Situations where direct visualization may improve outcomes
Step-by-Step: What to Expect from Rhinoplasty
Step 1: Consultation
- Dr. Westreich evaluates your nasal anatomy, reviews your cosmetic and functional goals, and recommends a surgical approach
- He explains the plan in plain terms and addresses all questions before moving forward
Step 2: Pre-surgical preparation
- Patients receive detailed pre-surgical instructions covering medications to pause, smoking requirements, and what to arrange at home for recovery
- A health clearance and pre-operative labs may be required, depending on the procedure
Step 3: Anesthesia
- Rhinoplasty is performed under local or general anesthesia, chosen based on the complexity of the procedure and the patient's individual needs and preferences
Step 4: Surgery
- The procedure typically takes between 2 and 3.5 hours
- Dr. Westreich makes the appropriate incisions, reshapes cartilage and bone, places any grafts or sutures required, then closes the incisions and applies a nasal splint
Step 5: Immediate post-op
- Most patients go home the same day
- Dr. Westreich uses Exparel, a long-acting local anesthetic, which provides up to three days of post-operative comfort and reduces reliance on narcotic pain medications
Rhinoplasty Recovery Timeline
Days 1 to 7: A nasal splint is worn for approximately five to seven days. Bruising and swelling around the eyes and nose are expected and normal. Most patients take one week away from work or school.
Weeks 2 to 4: Bruising resolves, and swelling continues to decrease noticeably. Strenuous activity should be avoided for two to three weeks.
Months 1 to 3: The nose begins to look more refined as swelling subsides. Most patients feel comfortable in social and professional settings by this stage.
Months 3 to 12: Final results develop gradually. Tip definition, in particular, continues to refine for up to one year as the last of the swelling resolves.
Rhinoplasty Cost and Financing in NYC
Cosmetic rhinoplasty is not covered by health insurance. When the procedure addresses a functional issue, such as a deviated septum or structural airway obstruction, a portion of the cost may qualify for partial insurance coverage.
Factors that influence the total cost of rhinoplasty in New York City include:
- Surgeon's fees
- Anesthesia fees
- Surgical facility fees
- Pre-operative medical tests
- Post-operative medications and follow-up visits
New Face NY provides an itemized cost overview at consultation so patients understand exactly what to expect. Financing options are available through our office. Ask our team about current plans during your consultation, or visit the Financing page on our website.
Frequently Asked Questions About Open and Closed Rhinoplasty
Is closed rhinoplasty less effective than open rhinoplasty?
Closed rhinoplasty achieves the same full range of corrections as the open approach in the vast majority of primary rhinoplasty cases. Effectiveness depends far more on the surgeon's expertise with the endonasal technique than on the approach itself. Dr. Westreich's extensive published research and two decades of closed rhinoplasty outcomes speak to what is possible with this method. When patients ask him why other surgeons said their cases needed to be done open, Dr. Westreich’s response is “I agree that they would need to do it open.” Effectiveness is based on experience and training, not on approach.
Will I have a scar after my rhinoplasty?
Closed rhinoplasty leaves no external scarring. Open rhinoplasty leaves a small incision on the underside of the columella, which is typically not visible from standard viewing angles and fades considerably over several months.
Can rhinoplasty correct both cosmetic and functional problems at the same time?
Yes. Dr. Westreich's training in both facial plastic surgery and Otolaryngology positions him to address cosmetic and functional concerns in a single procedure. Combining a cosmetic rhinoplasty with a septoplasty may also allow the functional component to qualify for partial insurance coverage.
How long does full recovery take?
Most patients return to work within one week and see a marked reduction in visible bruising and swelling within two to three weeks. Final results, particularly tip definition, develop over the course of up to one year.
What if I need a revision rhinoplasty?
Revision rhinoplasty addresses cosmetic or functional concerns that remain after a prior surgery. Dr. Westreich evaluates each revision case individually. The open approach is often considered for these cases, given the added complexity of working with previously altered anatomy.
Does Dr. Westreich perform both open and closed rhinoplasty?
Yes. Dr. Westreich is proficient in both techniques and selects the appropriate approach based on each patient's anatomy and surgical goals. His strong preference for the closed approach does not mean he applies it universally; he uses the open approach whenever the case demands it.
Talk to Dr. Westreich to Find Out Which Rhinoplasty Approach Is Right for You
The right technique depends on your anatomy, your goals, and the specific changes your nose requires, and that determination can only be made through a thorough, in-person evaluation.
Dr. Westreich's consultations are built around that conversation. He takes the time to examine your nasal structure, understand what you want to change and what you want to keep, and explain his recommended approach in clear, understandable language. Contact us today to book your consultation and learn more.
Disclaimer: This information is provided for educational purposes only and does not replace a consultation with a board-certified facial plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.
Sources
- American Academy of Facial Plastic and Reconstructive Surgery. Board Certification. https://www.aafprs.org/
- Westreich RW, Lawson W. The Tripod Theory of Nasal Tip Support Revisited: The Cantilevered Spring Model. Archives of Facial Plastic Surgery. 2008. https://www.datocms-assets.com/119571/1719861243-westreich-lawson-2008-the-tripod-theory-of-nasal-tip-support-revisited.pdf
- Lee Y, Lee J, Luo J, Lawson W, Westreich R. The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty. Plastic and Reconstructive Surgery. 2021. https://journals.lww.com/plasreconsurg/abstract/2021/05000/the_utility_of_the_subalar_graft_in_nostril.7.aspx
