Rhinoplasty is surgery of the nose. The aim is to improve breathing or the shape of the nose or both. When the septum is crooked, and the aim of the procedure is to straighten the septum, the operation is called a septoplasty.

There are essentially two main ways in which a rhinoplasty can be performed. It can either be by an open rhinoplasty, or a closed rhinoplasty. By open rhinoplasty, we are referring to the technique where an incision is placed across the columella, and then extended into the nose. By closed rhinoplasty, we are referring to the rhinoplasty technique where all the incisions are placed inside the nose.

With open rhinoplasty, the incision can either be an inverted ‘v’, which is placed across the columella and extended into the nose, or a ‘stair-step’ incision, which is also placed across the columella and extended into the nose. The skin is then lifted from the underlying cartilage and bone framework, and the necessary or required maneuvers are then performed to either improve the shape or improve breathing or both.



With closed rhinoplasty, all the incisions are placed inside the nose, and the type of incision depends entirely on what the surgeon is trying to achieve, or which parts of the nose he or she requires access to. The common incisions inside the nose include the intramembranous incision, hemitransfixion incision, infracartilaginous incision, and the transcartilaginous incision.
When it comes to deciding which technique to use, it generally comes down to a combination of the surgeon’s preference, the complexity of the procedure, and to a certain extend the choice of the patient. In terms of the surgeon’s preference, it is usually a reflection of the surgeon’s training and experience. There are however a small group of surgeons who are dexterous at both techniques.

The complexity of the procedure also has a bearing as to which technique is more appropriate. It is generally accepted that more complex procedures, such as those required for revision surgery, are better done with the open approach. Cartilage grafts may be necessary and precision is of the utmost importance. Some patients prefer the closed approach as it is generally accepted that recovery times as well as swelling are reduced.

The cost of the procedure is also dependent on the surgeon and his or her location. Those in larger metropolitan cities on the whole would charge more.
With regards to recovery, if the nasal bones are fractured, a nasal cast is required for a week irrespective of technique. Swelling, seen in both techniques, resolves faster following a closed approach. Even though this will vary from patient to patient, as a general rule of thumb, it is accepted that 90% of the swelling in open rhinoplasty settles after 3 months. This is in contrast to the closed approach where a shorter period of six to eight weeks is usually sufficient to see the same outcome.

As with any surgery, it is important to be mindful of the potential risks associated with rhinoplasty. These include infection, bleeding, scarring, nostril asymmetry, difficulties with the airway, dissatisfaction with the outcome and the need for revision. There are currently no studies that have compared the two techniques in terms of safety.

Open rhinoplasty

If you need further information, or would like to book a consultation, please contact Dr Ivo Gwanmesia’s office on 02074741300 or fill out the contact form at

Dr Ivo Gwanmesia

Dr Ivo Gwanmesia is one of Harley Street’s most experienced and renowned craniofacial plastic surgeons. With over a decade of professional experience, he has transformed the lives of countless patients from all over the UK & abroad.

Due to his vast and hands-on training in the UK and the US, Dr Ivo now specialises in more than a dozen different aesthetic, craniofacial and transgender procedures. Some of them include face, neck, and brow lifts, upper and lower blepharoplasty, breast reduction & breast uplift as well as facial feminisation surgery, to name a few.

Dr Gwanmesia has also conducted pioneering research, which led to the development of a new technique for the reconstruction of the middle vault of the nose, known as the ‘Fulcrum Spreader Graft’. He was also part of a study comparing the efficacy of the Sheen Spreader Graft and the Fulcrum Spreader Graft. The study has since been published on PubMed and the Journal of the American Society of Plastic Surgeons.