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The Open Rhinoplasty Approach

The open rhinoplasty approach is considered by many to be a modern method of performing rhinoplasty. The incision is made between the nostrils in an area called the columella. This columellar incision allows us to elevate the skin and directly visualize the tip and underlying nasal structures.

Below is an example of the open rhinoplasty approach, with the green line showing the inverted gull-wing incision:

Open Rhinoplasty Approach

Below is an example of another type of open approach incision called the stair-step transcolumellar incision. Both techniques are commonly used. We typically use the inverted gull-wing approach, which was refined through training with Beverly Hills facial plastic surgeons, including Dr. Paul Nassif, Dr. Francis Palmer, Dr. Stephen Pincus, and Dr. Mark Berman. Below is a view of the open approach after the incision is made and the structures are fully exposed, allowing for maximum visualization.

Open Rhinoplasty Approach

Benefits of the Open Approach

The open rhinoplasty approach provides a clear, direct view of the nasal structures, allowing for more precise adjustments.

Even with this level of visibility, rhinoplasty is still a complex procedure. The nose is made up of fat, soft tissue, muscle, bone, cartilage, skin, and mucosa—all of which must be carefully adjusted to work together harmoniously. The open approach makes this process more controlled and predictable.

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Rhinoplasty Before & After

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Considerations of the Open Approach

Some concerns associated with the open approach include the small scar along the columella. In most cases, this scar heals well and becomes minimally noticeable.

There may also be a slightly longer healing period compared to other techniques. As with any incision, there is a small risk of healing issues, which could affect scarring or tissue quality in this area.

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The Closed Rhinoplasty Approach

The closed rhinoplasty approach is similar to the open approach but does not include an external incision on the columella. All incisions are made inside the nose, and the structures remain covered.

While there are techniques to expose the tip cartilages during a closed procedure, the visualization is more limited. The structures may appear distorted during surgery and only return to their natural shape once the skin is repositioned.

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Benefits of the Closed Approach

Supporters of the closed approach often highlight:

  • Faster healing times
  • No visible external scar
  • Reduced risk of disruption to the columellar tissue

Pre-Treatment Guidelines

To reduce the risk of bruising, you may be advised to stop taking fish oil, Vitamin E, herbal medications, supplements, aspirin, and anti-inflammatories 1–2 weeks prior to treatment, if possible. Please inform us of all prescriptions, over-the-counter medications, herbal supplements, and topical products you are using, and let us know if you may be pregnant.

Additional Resources

Please consult our Patient Care section for more helpful information. You can also review our privacy policy on the resources page.

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