What is open rhinoplasty?
Open rhinoplasty — the external approach — uses the same internal incisions as the closed technique plus one short incision across the columella, the strip of skin between the nostrils. Through it the skin of the lower nose is lifted, and the cartilage framework is exposed under direct vision.
That single extra incision is the whole difference. Everything else — the goals, the anaesthesia, the hospital stay, the general shape of recovery — is common to rhinoplasty as a whole.
Why would direct exposure be worth an extra incision?
The tip of the nose is built from paired cartilages that are rarely perfectly symmetrical. Working through internal incisions, a surgeon reaches them one at a time and largely by feel. Working through an open exposure, both are visible at once and can be compared, marked, sutured and grafted against each other.
This matters most when:
- the tip is visibly asymmetric or twisted;
- cartilage grafts are planned to support or reshape the tip;
- the nose has been operated on before and the anatomy is scarred or unpredictable;
- the nasal valve is collapsing and structural support has to be added precisely;
- a major change in tip projection or rotation is planned.
Constantian's series of consecutive secondary rhinoplasty patients described different patterns of residual deformity following the two approaches — one of the observations behind the modern practice of selecting the approach case by case rather than by habit.
How does it compare with the closed technique?
| Open | Closed | |
|---|---|---|
| Columellar incision | Yes, a few millimetres | No |
| View of the framework | Direct, both sides together | Indirect, more limited |
| Precision of tip suturing and grafting | Higher | Lower |
| Soft tissue lifted | More | Less |
| Early tip swelling | More, settles more slowly | Less |
| Common indications | Complex tip work, asymmetry, revision, valve support | Hump reduction, moderate reshaping |
Neither column is a verdict. A straightforward profile correction does not become better because it was done through an open approach, and a complex reconstruction does not become safer because it avoided an incision. The full comparison is set out on the main rhinoplasty page, and the alternative is described under closed rhinoplasty.
How is the operation performed?
- Anaesthesia. General anaesthesia, with anaesthetic assessment beforehand.
- Columellar incision. A short, usually stepped or V-shaped incision is made across the columella and joined to incisions inside the nostrils.
- Exposure. The skin of the lower nose is lifted, exposing the tip cartilages and the dorsum.
- Framework work. The dorsum is reduced or straightened; tip cartilages are trimmed, sutured, repositioned or supported with grafts, most often taken from the septum.
- Airway. Septal deviation and turbinate enlargement are corrected where planned; support grafts are placed if the nasal valve is collapsing.
- Bone. Where the nasal width is being changed, controlled cuts are made in the nasal bones — with classical instruments or with ultrasonic devices.
- Closure. The columellar incision is closed with fine sutures; an external splint is applied, with internal splints in many cases.
What does recovery look like?
| Period | What is usual |
|---|---|
| Days 1–2 | Blockage and pressure; swelling around the eyes begins |
| Days 3–5 | Bruising most visible, then fading |
| Day 6–7 | Splint removed, columellar sutures removed |
| Weeks 2–3 | Most bruising resolved; many return to work |
| Weeks 4–6 | Light exercise usually resumed |
| Months 3–9 | Tip swelling settles gradually — slower than after closed surgery |
| Month 12+ | Shape considered settled; the tip refines last |
The columellar scar goes through a predictable sequence: firm and pink for the first weeks, then softening and fading over several months. Keeping it out of strong direct sun during that period helps. Some patients are advised on scar massage or silicone products; that advice is given individually.
What are the risks?
In addition to the risks common to all rhinoplasty — bleeding, infection, prolonged swelling, contour irregularity, asymmetry, temporary numbness, breathing difficulty, and the possibility of wanting further surgery — the open approach carries two specific considerations:
- The columellar scar. Usually inconspicuous, but scar healing varies between people and cannot be promised in advance.
- More pronounced and longer-lasting tip swelling. This is expected rather than a complication, but it means the final result is judged later than after a closed operation.
Individual risks are discussed at consultation and again during the informed consent process. Results vary; no outcome is guaranteed.
What affects the price?
Cost follows the complexity of the plan rather than the approach: whether grafting is needed, whether the septum and turbinates are being treated, whether this is a first or a revision operation, the length of the operation, and the hospital.
No prices are published here and no figure can be quoted before an examination. See the Medical Disclaimer.
What is the process for patients travelling to Izmir?
Online first contact, examination and consultation in Izmir, pre-operative tests, surgery with one night in hospital, splint and suture removal around day six or seven, and follow-up that continues online after you return home. A stay of about seven days covers the sequence.
Because the tip settles more slowly after an open operation, patients are asked to judge the result over months rather than weeks. Follow-up photographs at three, six and twelve months are part of that.