[Fukuoka] What Is Closed Rhinoplasty? Differences from the Open Technique, Scars, Cost & Downtime, Explained by a Surgeon

Many procedures can be performed with the closed technique: tip plasty to refine the nasal tip, augmentation rhinoplasty to build up the bridge, septal extension to lengthen the tip, and more. By contrast, the "open technique" also cuts the skin between the nostrils (the columella) and opens the nose up widely. Neither is simply better than the other — think of them as approaches to be chosen according to the change you want and the concern you have.

Scars are barely visible from the outside

All incisions are completed inside the nostrils. With the open technique, the scar on the columella (under the nose) can be noticeable at close distance, but the closed technique does not cut the outer skin, so scars are barely visible from the outside. It is especially well suited to people who do not want anyone to realize they have had surgery.

Downtime tends to be relatively short

Because the columella is not incised, swelling and bruising tend to subside sooner (depending on the procedure). It is often chosen by people who cannot take long time off work or school.

Results tend to be more stable

Since the skin is never opened up widely, the result is less affected by suture tension at closure, so the shape created during surgery is easier to preserve through to the final outcome — a real technical advantage. Swelling is also easier to keep down, allowing us to refine the result down to how the nose looks immediately after surgery.

That said, there is no need to assume that "big changes are impossible with the closed technique." Advances in instruments have expanded what it can handle: with endoscopic assistance to widen the field, even high-change procedures such as fully autologous rhinoplasty using rib cartilage are possible through the closed approach.

No compromise on the choice of cartilage (graft)

For procedures that need a solid foundation — such as septal extension, which lengthens the tip downward — your own rib cartilage (costal cartilage), with its strength, is sometimes the ideal material. However, harvesting rib cartilage demands real skill, so surgeons who cannot harvest it may substitute the easier-to-handle ear cartilage, or make preserved donor cartilage (cartilage donated by another person) their first choice.

Because Dr. Hane can harvest autologous rib cartilage himself, there are no constraints on the choice of material. Rather than relying on substitutes for the surgeon's convenience, he selects the material genuinely suited to each case. We consider your own tissue (autologous tissue) first, and propose the optimal graft according to the strength and volume required.* Every material has advantages and caveats; the final choice is made after an in-person examination.

Concern 1: Bulbous nose (rounded tip)

A bulbous nose — a tip that looks round — is almost never resolved by tip plasty alone. We use the closed technique to combine tip plasty, cartilage grafting, and a strut (a support that underpins the tip), building the tip's height and definition from the foundation up.

Concern 2: A low bridge (wanting a defined nose line)

If you want to define the bridge while also refining the tip, we use the closed technique to combine tip plasty, cartilage grafting, and a strut with dorsal augmentation (autologous tissue or an implant). The material used to raise the bridge can be autologous tissue (such as ear cartilage) or an implant, chosen to suit your nose and your wishes.* The case below used autologous tissue (ear cartilage).

Concern 3: Wanting a taller, more projected tip

To bring the tip clearly higher and further forward, we use the closed technique to combine tip plasty, cartilage grafting, septal extension, an implant, and other techniques, designing the nose three-dimensionally from the foundation up.* Alar reduction is not a required procedure for raising the tip. In the case below, alar reduction was performed as well.

The point most often overlooked is how case photos are presented. The nose is a three-dimensional feature, and its impression changes completely depending on the viewing angle. Some clinics show only side or oblique views, but you can only judge the true result by seeing all three views, including the front. A tip that looks sharp from the side may show no columella from the front; a nose that looks beautiful from the front may show a drooping tip from the side — some clinics hide such issues by publishing only the flattering angles.