Open rhinoplasty at a glance
- Incision
- Across the columella, plus cuts inside the nostrils
- Operation
- Usually 2 to 3 hours, under general anaesthesia
- Outer splint
- About 7 days
- Time in Istanbul
- 7 to 10 days
- Price range
- $3,000 to $5,500
Typical values for a first rhinoplasty. A revision takes longer and is priced separately. Your own plan, approach and price are confirmed after the photo review and the examination.
What is open rhinoplasty, and where is the incision?
Open rhinoplasty means the surgeon reaches the nasal framework through one small incision on the outside of the nose, across the columella, together with incisions inside the nostrils. The columella is the narrow band of skin that separates the two nostrils at the base of the nose.
The outer incision is usually shaped as a stair-step or a shallow V so that the scar does not run in a straight line. The surgeon then lifts the skin and soft tissue of the nose upward, like opening a flap, and sees the lower cartilages, the bridge and the upper cartilages in one view. At the end of the operation the skin is laid back and stitched, and the stitches are removed at the clinic when the splint comes off.
The term describes access, not a different goal. The same changes to the bridge, the tip or the width can often be planned through either approach. The direct comparison of the two approaches is a separate article; the sister page on closed rhinoplasty explains the other approach in full.
What does the open approach let the surgeon do?
The open approach lets the surgeon see and handle the cartilage of the tip directly, measure it, and place sutures and grafts under vision. Most of its uses follow from that single advantage.
- Rebuild the tip. When the lower cartilages are weak, asymmetric or too wide, they can be reshaped and held with sutures, not just trimmed.
- Place structural grafts. Cartilage from the septum, the ear or a rib can be shaped and fixed under the tip or along the side walls, where a precise position matters.
- Correct larger asymmetry. A twisted bridge or a tip that sits to one side can be assessed as one structure and corrected step by step.
- Work on the septum and the valves. The inside of the nose is reachable from above, which helps when breathing is treated in the same operation, as in a septorhinoplasty.
- Operate on a nose that was operated on before. Scar tissue and missing support are easier to read when the framework is in view.
Seeing more does not mean changing more. A careful plan still removes or alters only what the nose needs, and the amount of work depends on the plan, not on the approach.
Which noses is open rhinoplasty chosen for, and which may not need it?
Open rhinoplasty is usually considered when the plan involves the tip, grafts or a previous operation, and it may be unnecessary when the change is small and limited to the bridge. The table shows how the surgeon thinks about common situations.
| Nose or plan | How the open approach helps | What to ask at the examination |
|---|---|---|
| Wide, drooping or asymmetric tip | The lower cartilages can be reshaped, supported and checked for symmetry in view. | Which sutures or grafts will hold the tip, and what remains if the skin is thick. |
| Thick or oily skin | Strong support can be built under the skin, which matters more than removing tissue. | How long the tip may stay swollen and how definition is expected to develop. |
| Crooked nose with a deviated septum | The bridge, the septum and the side walls can be corrected in one plan. | How breathing will be assessed and treated. |
| Cartilage grafts planned | Grafts are shaped and fixed in an exact position. | Where the cartilage will come from and what happens if it is not enough. |
| Second operation on the nose | Scar tissue and lost support can be seen and rebuilt. | What the first operation changed and what limits remain. |
| Small hump and an otherwise balanced tip | Often not needed. The plan may be possible through inner incisions only. | Whether a closed approach can reach everything on your plan. |
Thick skin and second operations are covered in more detail on the pages about thick skin nose surgery and revision rhinoplasty. A person who does not want any cut on the outside of the nose should say so at the first call. It does not rule out the open approach, but it should be part of the discussion and not a surprise on the day.
What does the scar from open rhinoplasty look like, and how does it heal?
The open approach leaves a small scar under the nose, across the columella, which usually becomes hard to see after a few months. It is a real scar, and how it looks depends on your skin, on how the wound is closed and on how you care for it afterwards.
Healing follows a pattern. At first the line is red, a little raised and sometimes stiff or numb. As the weeks pass the redness fades and the tissue softens. The line sits in the shadow under the tip, where it is rarely seen from the front.
- Tell the surgeon if you have scarred thickly after a cut before, or if you tend to form raised scars. This changes the advice.
- Keep the area clean and follow the wound instructions you are given. Do not pick at crusts.
- Protect the scar from strong sun, because new scars darken more easily.
- Do not use creams, tapes or silicone products unless the team advises them.
Visible scarring or slow healing is possible and cannot be ruled out in advance. If the line stays red, wide or raised, it can be reviewed and treated, and the earlier the team sees it, the more options there are. Photographs sent during follow-up help.
What happens during an open rhinoplasty?
The operation is done in a hospital under general anaesthesia and usually takes 2 to 3 hours. It follows the plan agreed at the examination, step by step.
- Anaesthesia. An anaesthetist stays with you throughout.
- Incisions. The inner cuts are made inside the nostrils and the small outer cut across the columella.
- Exposure. The skin is lifted and the cartilage and bone are seen directly.
- Shaping. The bridge, the tip and the width are changed as planned, and the septum is treated if it needs it.
- Grafts. If the plan includes grafts, the cartilage is taken from the septum, the ear or a rib, shaped and fixed in place.
- Closing. The skin is laid back and stitched, soft internal splints are placed if needed and an outer splint protects the new shape.
The hospital stay is the same as for any rhinoplasty, and the plan states it. The step-by-step version for a first operation is on the primary rhinoplasty page.
How is recovery after open rhinoplasty?
Recovery after open rhinoplasty follows the usual course of nose surgery: swelling, bruising and a blocked feeling first, then a slow settling over months. The outer splint stays on for about 7 days and is removed at the clinic together with the stitches.
Some effects are more common after the open approach, because the skin of the tip has been lifted and the nerves there take time to recover.
- Tip swelling can last longer than swelling of the bridge, sometimes many months, and longer again with thick skin.
- The tip and the skin under the nose can feel numb or hard for weeks or months. This is usually temporary.
- The scar line is red at first and fades gradually.
- The final shape is usually seen after about a year.
How much of this you notice depends on the extent of the work, on your skin and on how you heal, more than on the label of the approach. The rhinoplasty recovery guide covers the weeks after any rhinoplasty, including what to avoid and when to call the team. Fever, increasing pain, spreading redness, heavy bleeding or a wound that opens need prompt medical help where you are.
- Day 1
- Discharge from hospital. Rest at the hotel with the head raised.
- Day 7
- The splint and stitches are removed at the clinic.
- Weeks 2 to 3
- Most of the bruising has faded. Most patients return to desk work.
- Week 6
- Sport is usually allowed again after the surgeon’s check.
- Month 3
- Most of the visible swelling has gone. The tip is still settling.
- Months 6 to 12
- The remaining swelling, mostly at the tip, goes down slowly. The final shape develops over this period.
What are the risks and limits of the open approach?
The open approach carries the general risks of any rhinoplasty, plus a few that come from the outer incision and the lifted skin. None of them is certain, and most can be made less likely by planning and by following the aftercare.
- A visible or slow-healing scar under the nose.
- Swelling of the tip that settles slowly.
- Numbness or hardness of the tip for a period.
- Bleeding, infection, asymmetry or irregularities, as with any nose operation. A small touch-up is occasionally needed after a year.
- Anaesthesia risks, assessed before surgery with your tests and history.
The approach does not change what rhinoplasty cannot do. It cannot copy another nose, it cannot give a thick-skinned tip a sharp outline and it cannot promise a result. More exposure gives the surgeon more control, not a promised result.
Does open rhinoplasty cost more?
The approach is not priced on its own. Prices are set per operation, so a first rhinoplasty generally costs $3,000 to $5,500 whether it is planned open or closed, and a revision generally costs $5,000 to $8,500.
What moves a price within a range is the work the plan needs, which is often why an open approach is chosen in the first place.
- How much of the tip, bridge and width has to change.
- Whether cartilage grafts are needed, and whether they come from the septum, the ear or a rib.
- Whether breathing is treated in the same operation.
- The hospital, the length of the stay and what the package includes.
Your exact price comes with your written plan after the photo review. The cost page shows the ranges for all six nose operations and what a package includes.
How is the choice between open and closed made at the examination?
The surgeon chooses the approach after examining the nose, because the approach has to match the plan. It is not a technique offered to everyone, and it is not decided from a photograph alone.
- You send photographs from the front, both sides and below, and describe what you want to change and any breathing problem.
- The surgeon reviews them and talks the plan through with you on a video call.
- At the examination the skin, the tip cartilages, the septum and the valves are checked by hand and by looking inside the nose.
- The surgeon names the changes needed, then the approach that reaches them safely, and explains the alternative.
- The written plan states the approach, the grafts if any, the limits and the follow-up.
You can start the process through the online nose analysis. The about page describes the surgeon and the clinic, and the revision rhinoplasty page in Turkey covers how to judge a plan for a second operation.
Medically reviewed by Op. Dr. Kemal Caner Delioğlu, ENT and head and neck surgeon ·
