Open Rhinoplasty Procedure: A Comprehensive Guide to Nose Surgery

content writer/ April 17, 2025/ Nose surgery/ 0 comments

Open rhinoplasty is a widely used cosmetic surgery that involves reshaping the nasal bone, cartilage, and soft tissues to improve both aesthetic appearance and functional aspects. This procedure is commonly sought by individuals looking to enhance their nose’s shape for aesthetic rhinoplasty or those seeking relief from functional issues like a deviated septum. Open rhinoplasty is a precise and intricate facial plastic surgery technique that allows for better visibility and access to the nose’s internal structures, offering patients more accurate results.

In this comprehensive guide, we will explore the details of the open rhinoplasty procedure, its benefits, risks, recovery process, and the various factors determining whether this is the right approach for you. We will also discuss revision rhinoplasty and primary rhinoplasty, and how this procedure can impact the nose’s cosmetic and functional aspects.

What is Open Rhinoplasty?

Open rhinoplasty is a nose surgery that corrects aesthetic and functional nasal issues. The procedure involves making a small incision across the columella, the tissue separating the two nostrils, and lifting the nasal skin to expose the underlying nasal bones and cartilages. This approach provides surgeons with a clear view of the internal nasal structures, allowing for greater precision in shaping the nasal dorsum (the bridge of the nose), nasal tip, septal cartilage, and other nose components.

Unlike closed rhinoplasty, where incisions are made inside the nostrils, open rhinoplasty offers direct visibility of the upper lateral cartilages, lower lateral cartilages, and nasal septum. This makes it especially beneficial for patients with more complex nasal issues, such as those requiring dorsal augmentation, tip projection, or corrections to nasal form.

Indications for Open Rhinoplasty

Open rhinoplasty is suitable for primary rhinoplasty patients (those undergoing surgery for the first time) and revision rhinoplasty patients (those seeking corrections after a previous nose job). Common reasons for choosing open rhinoplasty include:

• Cosmetic concerns: Many people are dissatisfied with the appearance of their noses, including issues with the nasal dorsum, nasal tip, or overall shape and size.
• Functional concerns: Correction of a deviated septum or nasal obstruction that affects breathing.
• Revision rhinoplasty: For individuals seeking to correct previous nose surgery or unsatisfactory cosmetic rhinoplasty results.

Steps Involved in the Open Rhinoplasty Procedure

The open rhinoplasty procedure typically follows these general steps:

1. Preoperative Planning and Consultation

Before undergoing open rhinoplasty, the patient meets with the experienced surgeon for a detailed consultation. The surgeon assesses the nasal form, takes photographs, and discusses the desired outcomes. Additionally, the surgeon evaluates preoperative risk factors, such as the patient’s medical history, allergies, and any history of bleeding disorders, as these could impact the procedure.

2. Anesthesia Administration

For open rhinoplasty, general anesthesia is typically used to ensure the patient remains comfortable and pain-free throughout the procedure. In some cases, intravenous sedation may be used, but general anesthesia is more common for this type of surgery. A breathing tube may be required to assist with respiration during the surgery.

3. Incision and Access

To access the nasal cavity, the surgeon makes a small, inconspicuous incision along the columella, the area between the two nostrils. The skin is then lifted to expose the upper lateral cartilages, nasal dorsum, and other internal structures of the nose, allowing for greater precision in reshaping.

4. Reshaping the Nasal Structures

Once the nose’s internal structures are exposed, the surgeon can reshape the nasal bones, cartilage, and soft tissues to achieve the desired result. This may involve:

• Reshaping the nasal dorsum (the bridge of the nose) by removing or reducing a dorsal hump or bony dorsum.
• Reshaping the nasal tip by modifying the lower lateral cartilage, adjusting the tip projection, or correcting asymmetry.
• Correcting the septum (the divider between the nostrils), often in cases where there is a deviated septum, to improve nasal function and breathing.
• Sculpting the alar cartilages and medial crura to refine the overall nasal shape.

In some cases, columellar strut grafts or septal cartilage may enhance structural support, particularly if nasal collapse or an open roof deformity is present.

5. Closing the Incision

Once the desired reshaping has been achieved, the surgeon carefully closes the incision using fine sutures. In most cases, the incision is barely noticeable once healed. Nasal packing may be applied inside the nose to support the newly shaped structures during the initial healing phase.

6. Postoperative Care and Recovery

After the surgery, the patient is monitored as the anesthesia wears off. Swelling and bruising are common in the first few days after surgery, especially around the eyes and nose. Cold compresses can help minimize swelling and edema during the initial recovery period.

During the first few weeks, patients are advised to avoid strenuous activity, nose blowing, and any actions that could interfere with healing. Follow-up appointments are necessary to ensure proper healing and to remove any nasal packing if used.

Benefits of Open Rhinoplasty

While closed rhinoplasty has certain advantages, open rhinoplasty offers several unique benefits:

• Increased precision and visibility: The open approach provides better access to the internal nasal structures, allowing for more accurate and customized reshaping.
• Ideal for complex cases: Open rhinoplasty is preferred for patients with significant functional issues (like a deviated septum) or aesthetic concerns (such as nasal dorsum issues, tip refinement, or revision rhinoplasty).
• Long-lasting results: Because the procedure allows for direct manipulation of the underlying cartilage and nasal tissues, the results are often more predictable and durable.

Potential Risks and Complications

As with any surgical procedure, open rhinoplasty comes with risks. Some potential complications include:

• Excessive bleeding or hematoma formation.
• Infection at the incision site or inside the nasal cavity.
• Scarring, although the incision is typically well-hidden.
• Asymmetry or dissatisfaction with results, which may require revision surgery.
• Nasal collapse or pug nose deformity if too much cartilage or bone is removed.
• Nerve irritation or altered sensation in the nose or upper lip.

It’s important to choose an experienced surgeon who specializes in aesthetic rhinoplasty to minimize these risks and ensure the best possible outcome.

Recovery After Open Rhinoplasty

The recovery process after open rhinoplasty varies from patient to patient but typically follows these stages:

First Week:

• Patients will likely experience swelling, bruising, and mild discomfort.
• The nose may be splinted, and nasal packing may be used to provide support.
• Cold compresses can help reduce swelling.

Weeks 2–4:

• Swelling and bruising begin to subside.
• The patient may still experience nasal congestion and difficulty breathing through the nose.
• Most patients can return to normal activities (excluding heavy physical exertion).

1–3 Months:

• Final swelling will begin to settle, and the shape of the nose will become more apparent.
• Nasal sensitivity may persist for several months.
• Follow-up appointments with the surgeon will monitor healing progress and assess the results.

6–12 Months:

• The final shape of the nose will become fully visible, with any residual swelling continuing to dissipate.
• Patients will have a much clearer picture of their results by this stage.

Why Choose Open Rhinoplasty?

Regarding rhinoplasty surgery, individuals seeking to enhance their nose’s appearance or function have multiple options. Among these options, open rhinoplasty is a highly effective and precise surgical technique that offers both cosmetic and functional benefits. Unlike the closed rhinoplasty procedure, where incisions are made inside the nostrils, open rhinoplasty involves an incision across the columella, the tissue between the nostrils, providing the surgeon with greater visibility and access to the internal structures of the nose. This detailed approach allows for more comprehensive alterations, making it ideal for various cosmetic and reconstructive needs. Below, we explore why open rhinoplasty is often the preferred choice for many patients, particularly primary ones, and how it can benefit those undergoing reconstructive surgery.

1. Greater Precision and Visibility

One of the primary reasons people opt for open rhinoplasty is the enhanced visibility and precision it offers. By incision along the columella, the surgeon can fully expose the internal nasal structures, including the nasal septum, upper and lower lateral cartilages, nasal dorsum, and nasal tip. This allows for better manipulation and reshaping of the cartilaginous dorsum, medial crura, nasal spine, and other components, providing a higher accuracy level than closed rhinoplasty.

The ability to see and work with the underlying cartilage and bone structures enables the surgeon to make more nuanced adjustments to the nasal form and correct issues such as dorsal hump or nasal tip projection. Additionally, it allows for improved graft placement, such as using columellar strut grafts or septal cartilage, to provide structural support and improve the longevity and appearance of the nose.

2. Ideal for Complex Nasal Corrections

Open rhinoplasty is particularly beneficial for patients who need significant adjustments to their nasal structure, such as dorsal augmentation, correction of a deviated septum, or reshaping of the nasal tip. In cases where the nasal cavity requires intricate reconstruction or where there are significant nasal deformities, such as those caused by trauma, birth defects, or prior rhinoplasty procedures, open rhinoplasty is often the go-to choice. The procedure allows the surgeon to perform reconstructive surgery on both the bony and cartilaginous dorsum with precision, offering superior control over the outcome.

In cases of revision rhinoplasty (when a patient undergoes surgery to correct issues from a previous nose job), the open rhinoplasty procedure provides better access to scar tissue. This allows the surgeon to address concerns such as a beak deformity or septal perforation that may have resulted from previous surgeries. The enhanced visibility and exposure that the open approach provides are crucial in achieving optimal results.

3. Customization for Aesthetic Goals

Every patient’s nasal anatomy is unique, and open rhinoplasty allows the surgeon to tailor the procedure to meet individual aesthetic goals. Whether the patient seeks a more balanced facial appearance, better nasal tip projection, or a more harmonious profile, the ability to precisely modify the nasal form using open rhinoplasty allows customized improvements.

For example, patients with thick nasal skin may benefit from the ability to sculpt better and adjust the underlying nasal structure. In contrast, patients with thin skin may require careful attention to avoid complications like scarring or visible deformities. By working directly with the underlying cartilage and nasal tissues, the surgeon can refine the nose’s shape while considering the patient’s unique anatomical features, resulting in a more aesthetically pleasing outcome.

4. Improved Nasal Function

While cosmetic rhinoplasty primarily focuses on the nose’s appearance, open rhinoplasty is also an excellent option for individuals seeking to improve nasal function. Many primary rhinoplasty patients also deal with functional issues, such as a deviated septum, nasal congestion, or difficulty breathing. Open rhinoplasty offers superior access to the nasal septum and the ability to correct internal obstructions, providing functional and aesthetic benefits in a single procedure.

For patients with nasal obstruction caused by a misaligned nasal septum, open rhinoplasty allows for better correction and straightening of the nasal septum. The surgeon can also adjust or reposition the caudal septum, the portion of the septum at the base of the nose, to improve airflow and alleviate breathing issues. The procedure can further address nasal packing or mucosal inflammation to improve nasal function if necessary.

5. Improved Long-Term Results

Due to the detailed nature of the procedure and the precise adjustments made during surgery, open rhinoplasty often leads to more predictable and long-lasting results than closed rhinoplasty. The ability to manipulate the nasal structure with greater accuracy reduces the likelihood of needing further surgical interventions (such as additional revision rhinoplasty). For primary rhinoplasty patients looking for aesthetic and functional improvements, open rhinoplasty provides a more comprehensive approach that yields lasting benefits.

In addition, open rhinoplasty allows for the use of structural grafts, such as columellar strut grafts or tip grafts, which can enhance the long-term stability and shape of the nose. These grafts can help prevent issues like nasal collapse or tip drooping that may occur after other types of rhinoplasty.

6. Recovery and Aftercare

Although open rhinoplasty is more invasive than closed rhinoplasty, the recovery process is typically straightforward when following the proper aftercare instructions. Most patients can expect some swelling, bruising, and discomfort during the first few days after surgery, particularly around the eyes and nose. However, this will gradually subside within a few weeks.

The nasal skin may remain swollen for several months, and it can take up to a year for the full results to be visible as the subcutaneous tissues and nasal tissues settle into their new shape. Pain relievers and cold compresses are typically used to manage discomfort and reduce swelling during the initial recovery period.

7. Minimizing Risks of Major Complications

While any surgical procedure has inherent risks, open rhinoplasty tends to have a lower rate of major complications when performed by an experienced surgeon. The visibility and access offered by the open approach allow for greater control and precision during the procedure, reducing the risk of complications such as septal hematoma, excessive bleeding, or nasal roof deformities.

In rare cases, patients may experience dissatisfaction with the final results due to issues such as nasal asymmetry or a poorly shaped nasal tip, which may require additional adjustments. However, with proper preoperative planning and a highly skilled surgeon, these risks can be minimized, and the results are generally more predictable compared to closed rhinoplasty.

8. The Role of Local Anesthesia and General Anesthesia

The open rhinoplasty procedure is typically performed under general anesthesia to ensure the patient’s comfort and safety throughout the surgery. General anesthesia ensures that the patient is completely unconscious during the procedure. In contrast, local anesthesia may be used to numb specific nose and surrounding tissue areas to minimize discomfort.

In some cases, intravenous sedation may be used alongside local anesthesia for a less invasive approach. The choice of anesthesia depends on the complexity of the surgery and the surgeon’s recommendation. Most patients can go home the same day of the procedure, though the length of the surgery will vary depending on the extent of the changes being made to the nose.

9. Postoperative Care and Follow-Up

After undergoing open rhinoplasty, the patient will receive detailed postoperative care instructions to ensure proper healing and minimize complications. This includes avoiding activities that may cause trauma to the nose, keeping the head elevated to reduce swelling, and refraining from blowing the nose for several weeks.

Follow-up appointments are essential to monitor recovery, remove nasal packing, and assess final results. Patients will likely be asked to return to the clinic for regular check-ups in the weeks and months following surgery.

10. The Importance of Choosing an Experienced Surgeon

Choosing the right facial plastic surgeon is one of the most important factors in achieving a successful outcome from open rhinoplasty. Look for a surgeon who specializes in aesthetic rhinoplasty and has extensive experience with both primary and revision rhinoplasty procedures. It’s also essential that the surgeon is familiar with the unique challenges of reconstructive surgery in the nasal area.

An experienced surgeon can assess your nasal anatomy, understand your aesthetic goals, and provide a personalized surgical plan that meets both your functional and cosmetic needs. They will also be able to guide you through the recovery process and ensure that the final results align with your expectations.

Conclusion

The open rhinoplasty procedure is a powerful tool in aesthetic surgery. It offers enhanced control, precision, and flexibility, making it ideal for primary rhinoplasty patients and those undergoing revision rhinoplasty. By providing greater access to the nasal cavity, nasal septum, and cartilage, this technique allows for intricate reshaping of the nasal dorsum, nasal tip, and other nose structures. With careful planning and expertise, open rhinoplasty can deliver natural, lasting results that improve nasal function and achieve the desired cosmetic improvements. If you are considering rhinoplasty surgery, consulting with an experienced facial plastic surgeon will ensure that you receive personalized care and achieve optimal results for your nose’s shape and overall appearance.

References

https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty

https://www.mayoclinic.org/tests-procedures/rhinoplasty/about/pac-20384532

https://my.clevelandclinic.org/health/treatments/11011-rhinoplasty#:~:text=What%20is%20rhinoplasty%3F,improves%20breathing%20and%20nasal%20function.