(Procedures)

What Type Of Nose Job Is Right For You? Here’s What The Experts Say To Consider

The rhinoplasty is evolving.

Michela Ravasio, Sergey Filimonov, Vera Lair/Stocksy, AlesVeluscek/Getty Images

According to the American Society of Plastic Surgeons, rhinoplasty, or the surgical reshaping of the nose, is consistently named as one of the top five most popular cosmetic procedures in the country. “There is no question that rhinoplasty was the number one procedure performed in the United States,” says board-certified facial plastic surgeon Dr. Corey S. Maas, 2021-2022 President of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). But the procedure has evolved to offer more options for how exactly the surgery approaches restructuring the nose, with both an open and closed rhinoplasty as options.

Double board-certified facial plastic surgeon Dr. Ben Talei explains that, “There is a strong trend towards a field called preservation rhinoplasty, [which] is a new and evolving field that uses the soft tissue connections and coverage in the nose to obtain the end result, rather than dismantling and restructuring [the anatomy of the nose as extensively].” In layman’s terms? It’s less deconstructive of a process, and can refer to either the closed or open nose job techniques.

Endonasal rhinoplasties — AKA closed nose jobs — are becoming more appealing than ever to patients who prefer the less aggressive approach due to the recovery, more minimal swelling, shorter procedure times, and natural-looking results. “If possible, most of my patients prefer the closed technique,” confirms board-certified plastic-surgeon Kimberly J. Lee. Although open nose jobs are largely considered the best approach for more complex cases, especially when the tip of the nose requires manipulation, it is admittedly more invasive and results in a longer downtime.

Board-certified plastic surgeon Raj Kanodia is known for being the preferred plastic surgeon among Hollywood's elite, exclusively performing scarless, closed nose jobs. "I prefer closed [nose jobs] because in over 90% of patients, I am able to refine the nose without having to inflict the scar,” he says. “My goal is to refine the nose but not change the character of the nose." Because closed nose jobs are ideal for less complex cases, they are also often quicker procedures (for reference, Dr. Kanodia’s procedure takes roughly ninety minutes compared to, sometimes, three hours).

So which option is right for you? Discover everything you’ll need to know about the two procedures.

How Do The Techniques Differ?

"A closed rhinoplasty is nose surgery that is done with all incisions on the inside of the nose whereas an open rhinoplasty involves a small incision across the columella (i.e., the area between the nostrils) to allow the nose to be opened to access the anatomical structures underneath," explains Dr. Lee.

“Surgeons that have predictable and reproducible results with closed rhinoplasty tend to avoid taking everything apart [whereas] open surgeons [may] do more restructuring,” Dr. Talei elaborates. For comparison, an open nose job allows the plastic surgeon to deconstruct and reconstruct the nasal framework with the benefit of full visuals — but the downtime is longer and swelling is more substantial.

It is important to note that both open and closed rhinoplasties can lower the bridge of the nose if desired (a reconstruction goal that you might not think is doable with a closed procedure). Dr. Talei clarifies that how this is achieved differs between the classic and preservation techniques (if you remember from above, the preservation technique is the field’s more contemporary evolution). In classic rhinoplasties, the bone is cut down from the top of the nose; in preservation, the bone is removed from the bottom, closer to the cheek.

Photo via Dr. Raj Kanodia

Surgeons can also use different tools (or “osteotomes”) for more or less invasive technique, whether performing an open or closed procedure. The rasp is a more traditional tool of choice, with Dr. Kanodia naming the maltz rasp as his preferred tool. But the newer, ultrasonic piezotome allows for incremental shaping without breaking the bone. "The piezotome machine is a game changer in our industry," Dr. Lee says. "It uses ultrasonic technology to allow shaving of the nasal hump smoothly and incrementally by fractions of millimeters."

But rather than focusing on his/her technique, it is more important to find a plastic surgeon whose demonstrated aesthetic matches your own — after all, you’ll be asleep during the surgery, but living with the results for the rest of your life. Always look through their galleries of before and after photos, taking note of such things as symmetry, curvature, and tip style.

What Results Can You Achieve With Closed Vs. Open Rhinoplasty?

Dr. Kanodia describes the prevailing, desired aesthetic requested by those in search of closed nose jobs as preserving character and looking "natural, but more balanced." But the fact is, these results can be achieved from either open or closed surgeries. The main draw of a closed rhinoplasty comes down to the lack of visible, external scarring following the procedure, as an open nose job leaves a small scar on the underside of the nose, only visible from the bottom looking up — and which can, of course, be lasered away. It is because of where the incisions are made that the open and closed approaches differ in external scarring.

While an open nose job unveils the underlying structures during surgery, the incisions in closed procedures are concealed within the nostril — hence the "scarless" results — without pulling the skin back to expose the nose’s underlying anatomy. As an added perk, board-certified plastic surgeon Dr. Kevin Sadati explains, “Open rhinoplasty is more expensive than closed since it requires more time and detail work.”

Who Is The Best Candidate For The Different Types Of Rhinoplasty?

“More complex cases, such as those requiring cartilage grafts, will require open surgeries,” says Dr. Sadati. Generally speaking, those looking for ultra-subtle, natural-looking results might want to look into a closed rhinoplasty. “The best candidates for closed nose jobs require simple modifications to the nasal tip or dorsum,” he says.

The consensus seems to be that complex cases requiring “more moves” to perform augmentation, revision, or reconstruction of the tip are better performed open. But when a patient presents with a great “tip nostril complex" and an unwanted bump along the bridge of the nose, the closed rhinoplasty consult can suffice.

Because Dr. Kanodia exclusively performs closed nose jobs, he will occasionally refer out patients that would benefit from an open procedure — most notably, when a tip needs reconstruction, or there is severe asymmetry between the tip and the nostril. "Individuals with really bulbous tips could use some reconstructive tip sculpting, and for that reason, I do refer them to colleagues I consider to be good open surgeons," he says.

Notably, either procedure — open or closed — can also be used to address breathing problems. "Patients often need to have nasal breathing problems addressed due to a deviated septum, sinus problems, or a nasal valve collapse,” says Dr. Lee. “[This repair] can be done at the same time,” via a septoplasty. Dr. Kanodia is passionate about this element of his rhinoplasties, pointing out that he has worked with many athletes to correct their breathing by performing closed septoplasties to enhance their professional careers.

Ultimately, Dr. Talei says that the decision to perform open or closed rhinoplasty for a given patient comes down to the training and preference of the surgeon. For instance, earlier in his career he preferred performing closed nose jobs; but later on in his evolution as a surgeon — and in the development of his specialty in revision rhinoplasties (i.e., to correct the work of former surgeons) — he has gravitated towards open nose jobs.

What Are The Differences In Recovery?

Other than the subtle and scarless results, Dr. Talei notes that the main benefits of a closed nose job is the lesser downtime, comparatively minimal swelling, and swifter recovery. "At about a week and a half, the swelling [on a closed nose job] will go down enough that no one will be able to tell that it was done." he says. Dr. Kanodia famously reveals his work to his patients after just seven-to-nine days. By contrast, Dr. Talei points out that it takes about three weeks for the obvious swelling to go down from an open procedure. That being said, Dr. Lee reiterates that over the long run, swelling from any rhinoplasty may ultimately last for up to a year; internally, healing continues for up to two years.

The beauty of the closed nose job is, of course, its subtlety. If you are hoping for a tweak that could very well be overlooked and heal in just over a week, a closed nose job might be your cup of tea. "Anyone with a natural mentality is a great candidate for closed rhinoplasty," Dr. Kanodia says, noting that patients often mention the noses of Megan Fox, Kim Kardashian, Bella Hadid, Ashlee Simpson, and Blake Lively as inspiration. "I always remind them that I can only refine the anatomy of the nose they have."