Open rhinoplasty is not a separate kind of nose job. It is a way of reaching the nasal framework: a small incision across the columella lets the surgeon fold the skin of the tip upwards and work on the cartilages under direct vision.
This page focuses on that access — the incision and the scar it leaves, the situations in which the open view is worth it, and what it means for swelling and recovery. For an overview of nose reshaping in general, see rhinoplasty in Ankara. The scarless alternative is described on the closed rhinoplasty page.
What does "open" actually mean?
Every rhinoplasty uses incisions inside the nostrils. In the open (external) approach, these are joined by a short incision across the columella, the skin bridge between the nostrils. The skin and soft tissue of the lower nose are then lifted like a hood.
With the skin lifted, the tip cartilages, the septum and the bridge are visible in their natural position. The surgeon can measure, trim, suture and reinforce them, then lay the skin back down and close the incision.
Reviews of the external approach stress a systematic order of steps, because every change to one part of the nose has knock-on effects on the others. Seeing the whole framework at once makes those effects easier to judge.
Where is the incision and what happens to the scar?
The columellar incision is usually made at the narrowest part of the columella, often with a small step or inverted-V shape so that the line is broken up and heals less noticeably. It is closed with very fine stitches.
In most patients the scar settles into a thin line that is difficult to see in normal conversation. It can look pink for some weeks before it fades.
| Question | What the evidence shows |
|---|---|
| Does stitch type matter? | A meta-analysis of 6 studies (435 patients) found no significant difference in long-term scar appearance between dissolving and non-dissolving sutures |
| How often do patients notice the scar? | In a study of 91 open rhinoplasty patients, 12 mentioned the columellar scar when asked about scars on their face |
| Does noticing it affect satisfaction? | In the same study, scar awareness was not linked to overall satisfaction with the operation |
| How common is a raised (hypertrophic) scar? | A systematic review of rhinoplasty adverse events reported rates between 0 and 1.5% |
Skin type, smoking and sun exposure all influence healing. Keeping the area clean, not picking at crusts and using sun protection in the first months are part of aftercare.
When is the open approach usually chosen?
The decision depends on what needs to change and how much structural work is involved. In general, the more the tip and the middle of the nose need to be rebuilt, the more useful the open view becomes.
| Situation | Why the open view helps |
|---|---|
| Asymmetric, wide or bulbous tip | The cartilages can be compared side by side and shaped with sutures under direct vision |
| Crooked (deviated) nose | The septum and upper cartilages can be straightened and supported precisely |
| Grafts are needed | Spreader grafts, a columellar strut or tip grafts can be placed and fixed accurately |
| Revision rhinoplasty | Scar tissue and the remains of earlier surgery can be assessed directly |
| Weak tip support or valve collapse | The framework can be reinforced so that breathing is protected |
| Combined function and shape | Septum, valve and tip work can be done in one sitting with a clear view |
A small hump with a well-shaped tip often does not need this level of access. In such cases the closed approach may be enough. Which one suits you is decided at the examination, not from photographs.
How do grafts fit into open rhinoplasty?
A graft is a small piece of cartilage used to support, straighten or add shape. The first choice is usually the patient's own septal cartilage; ear or rib cartilage may be considered when the septum has been used up or is weak, for example after earlier surgery.
Reviews of grafting techniques describe grafts for the bridge, the septum and the lower third of the nose. Fixing these grafts securely is easier when the framework is exposed, which is one reason the open approach is common in structural and revision rhinoplasty.
If grafts are likely in your case, this is explained at the consultation along with where the cartilage would come from.
How does open compare with closed rhinoplasty?
The two approaches reach the same structures through different doors. A 2025 meta-analysis of 12 comparative studies (1,067 patients) found no significant difference between open and closed rhinoplasty in patient-reported aesthetic outcome, nasal breathing scores, oedema, bruising, operating time, satisfaction or complication rates. The authors noted that study quality was moderate and that the choice should be tailored to the patient.
| Point | Open approach | Closed approach |
|---|---|---|
| External incision | Short line across the columella | None |
| View of the tip cartilages | Direct, both sides at once | Indirect, through the nostrils |
| Placing and fixing grafts | Straightforward | Possible, but more limited |
| Tip sensation | Temporary reduction is common in the first weeks | Less affected in the trial cited below |
| Typical use | Complex tip, crooked nose, grafting, revision | Bridge changes, limited tip work |
One randomised trial from Ankara measured skin sensation after both approaches. In the open group, sensation at the tip and the area just below it dropped at one month and was back to normal by the third month. The closed group showed no significant loss over the follow-up period.
What is recovery like after open rhinoplasty?
The first week is the most restricted. After that, recovery is mainly a matter of waiting for swelling to settle. Timelines vary between people; the table shows typical ranges.
| Time | What to expect |
|---|---|
| Days 1–3 | Blocked nose, pressure, swelling and bruising around the eyes; head raised, cold compresses |
| Day 6–7 | External splint removed, columellar stitches removed if non-dissolving; the nose looks puffy |
| Weeks 2–3 | Most bruising has faded; many people return to desk work |
| Weeks 4–6 | Strenuous exercise usually resumed; avoid knocks to the nose |
| Month 3 | Most of the visible swelling has gone |
| Months 12+ | Fine swelling at the tip continues to settle, longer with thick skin |
Because the skin over the tip has been lifted, the tip tends to stay firm and slightly full for longer than the bridge. This is expected and gradually improves. Taping the nose or gentle massage is sometimes advised; follow the instructions you are given.
How should I plan the trip to Ankara?
Ankara is served by Esenboğa International Airport, north of the city, with international flights and frequent connections through Istanbul. The clinic is in the Çankaya district.
| Step | When | What happens |
|---|---|---|
| Preliminary assessment | Weeks before travel | Photographs and medical history shared by WhatsApp or e-mail; a provisional opinion is given |
| Arrival and consultation | 1–2 days before surgery | Examination including the inside of the nose, photographs, final plan and informed consent |
| Surgery | Day 0 | Open rhinoplasty under anaesthesia; discharge arrangements explained in advance |
| Rest and check-ups | Days 1–5 | Rest at your accommodation; review visits as planned |
| Splint removal | Around day 6–7 | Splint and any stitches removed; the nose is checked |
| Flight home | Day 7–8 | Usually possible after splint removal |
| Remote follow-up | Months 1–12 | Photographs at agreed intervals |
A provisional opinion from photographs is not a diagnosis. The final plan is made only after the in-person examination.
What are the risks of open rhinoplasty?
Open rhinoplasty shares the risks of any nose surgery, plus a few related to the columellar incision. This list is not complete; your individual risks are discussed at the examination and during informed consent.
- Bleeding, nosebleeds or a collection of blood under the skin
- Infection
- Delayed healing or a visible or raised columellar scar
- Prolonged swelling of the tip
- Temporary numbness of the tip skin
- Breathing difficulty, temporary or, rarely, lasting
- Perforation of the septum
- Asymmetry or a shape different from the one planned
- Need for further surgery — a systematic review of rhinoplasty adverse events reported revision rates between 0 and 10.9% across studies
Why does an ENT surgeon's view matter here?
Open rhinoplasty is often chosen precisely because the nose needs structural work — straightening the septum, supporting a weak tip or opening a narrow valve. These are also the structures that keep the airway open.
Op. Dr. Serdar Başer is an ENT – head and neck surgeon whose practice focuses on rhinoplasty and functional nose surgery. Breathing is assessed alongside appearance, so that narrowing or reshaping the nose does not come at the cost of airflow.
This page is general information and does not replace a medical consultation. Whether the open approach is right for you is decided after an in-person examination.