Open rhinoplasty uses a small incision across the columella (the strip of skin between the nostrils) so the surgeon can lift the nasal skin and directly visualise the cartilage and bone. Closed rhinoplasty places every incision inside the nostrils, leaving no visible scar. Open is generally preferred for complex tip work, structural grafting, and revision cases; closed is better suited to more limited adjustments. The choice is made by the surgeon based on your anatomy and surgical goals, not by personal preference.
If you are researching rhinoplasty in Sydney and trying to understand which technique might apply to you, this guide walks through both approaches in plain terms. It covers what each involves, how the scar question is actually resolved, what the research says, and how Dr Peter Laniewski decides on the right technique at consultation.
Ready to discuss your own goals? Contact our team to book a consultation.
What Is Open Rhinoplasty?
Open rhinoplasty is the technique in which the surgeon makes a short incision across the columella, the narrow strip of tissue that separates the two nostrils at the base of the nose. This incision is typically around 4 to 5 mm long. It is made along the natural crease on the underside of the nose so that, once healed, it sits in a position that is difficult to see even at close range.
Once that columellar incision is connected to incisions inside the nostrils, the skin of the nose can be lifted back as a single flap. This gives the surgeon a direct, unobstructed view of the underlying cartilage framework and bone. The ability to see and work on both sides of the nasal tip at the same time is what makes open rhinoplasty the preferred technique for more involved surgical plans.
Open rhinoplasty is typically the route when detailed tip work or grafting is needed. The same applies when a deviated septum is being corrected at the same time as cosmetic changes, a condition known as septorhinoplasty, or when an earlier injury has left structural irregularities. Revision cases, where scarring from a previous procedure has to be worked around, also tend to call for it. Yes, the incision is slightly longer, but most surgeons regard that as a fair exchange for the added precision.
Healing of the columellar scar follows a fairly reliable pattern. At around the three-month mark, it has usually turned pale, and by the six-to-twelve-month point, it is hard to spot in everyday situations or in photographs. Proper wound care helps, as do silicone scar gel and LED light therapy after surgery.
What Is Closed Rhinoplasty?
Closed rhinoplasty places every incision entirely inside the nostrils. Because there is no external incision, there is no visible scar once healing is complete. This is the detail that many patients initially find appealing when they first start researching the procedure.
What you give up is visibility and access. Because the surgeon is working through small internal incisions, the skin cannot be lifted to reveal the underlying structures, so the nasal skin stays where it is, and much of the adjustment is guided by feel rather than direct sight. For more straightforward noses, that is perfectly workable. Where it falls short is in the more involved case, where the amount that can be achieved cleanly in one sitting is more limited.
Closed rhinoplasty earns its place in noses where the goals are modest. Think of a bridge that needs a touch of refinement, a small change at the tip, or a slight asymmetry to even out on a nose that is structurally sound to begin with. Push it further than that, though, and choosing a closed option mainly to avoid a scar can backfire, since the precision the larger change calls for becomes harder to achieve.
One point catches a lot of people out: closed rhinoplasty does not heal faster than open for most patients. The surgeon is working on the same internal tissues either way, so swelling settles on much the same schedule whether or not a columellar incision is made. It is a myth worth clearing up at the start.
Open vs Closed Rhinoplasty: Side-by-Side Comparison
The table below summarises the main differences between the two approaches.
| Element | Open rhinoplasty | Closed rhinoplasty |
|---|---|---|
| Incision location | Small cut across the columella (underside of the nose, between the nostrils) plus internal incisions |
All incisions inside the nostrils; no external cut |
| Surgeon visibility | Nasal skin is lifted back, giving direct view of cartilage and bone | Surgeon works through narrow nasal passages with limited direct view |
| Best suited to | Complex tip reshaping, structural grafting, post-traumatic cases, revision rhinoplasty, septorhinoplasty | Limited bridge adjustments, minor tip refinement, straightforward cases |
| Visible scarring | One small columellar scar, typically 4-5 mm; usually fades to near-invisible by 12 months | No visible scar |
| Operative time | Typically 30-60 minutes longer for an equivalent case | Shorter for comparable scope of work |
| Recovery | Similar overall timeline to closed; slightly more initial swelling at the columella | Comparable to open for most patients; not meaningfully faster in most cases |
It is worth stressing that having no visible scar does not, on its own, make closed rhinoplasty the smarter pick. The technique that suits you is whichever one lets the surgeon reach what needs adjusting and do it safely and accurately for your particular goals.
Which Technique Is Right for My Nose?
The honest answer is that this is determined at consultation, not before it. That said, there are some patterns that tend to point toward one approach over the other, and understanding them can help you come to your consultation with more informed questions.
Cases that typically point toward open rhinoplasty
- Significant tip reshaping is needed. The nasal tip involves a paired structure of cartilage that needs to be assessed and adjusted symmetrically. When detailed tip work is the primary goal, direct access makes a meaningful difference to the precision of the result.
- Structural grafting is planned. When cartilage grafts are being placed to reinforce or reshape the nose, particularly at the tip or along the bridge, open rhinoplasty allows the surgeon to place and secure grafts with greater accuracy.
- The patient has had rhinoplasty before. Revision cases involve scar tissue from the previous procedure, which alters the way tissue behaves. Open rhinoplasty gives the surgeon the visibility to navigate that environment more carefully.
- The nose has been affected by injury or trauma. Post-traumatic deformities often involve changes across multiple structural layers. Working with a direct view of the full framework makes it easier to plan and execute the repair in a single procedure.
- Septorhinoplasty is being performed. When both the internal airway and the external appearance need to be addressed, combining the work under an open approach avoids the need for a separate operation at a later date.
Cases that may be suited to closed rhinoplasty
- The changes required are limited in scope. A modest refinement to a prominent bridge, or a subtle adjustment to a specific area of the tip in a nose with a good underlying foundation, may be achievable through a closed approach.
- The patient has thin to moderate skin with predictable cartilage. Thicker nasal skin tends to obscure the tip definition and often benefits from the greater control that open access provides.
- There is a strong preference to avoid any external scar. In a select group of patients where the surgical goals genuinely fall within the scope of what closed rhinoplasty can achieve well, the absence of a columellar scar can be a meaningful consideration.
Skin thickness is also relevant to the overall outcome, regardless of technique. Patients with thicker nasal skin tend to have a longer refinement phase after surgery, because the skin takes longer to drape down over the reshaped framework. This affects the timeline for seeing the final result rather than the choice of technique itself, but it is worth discussing at the consultation.
Does Open Rhinoplasty Leave a Visible Scar?
The columellar scar from open rhinoplasty is approximately 4 to 5 mm long. It sits on the underside of the nose in the natural transition between the columella and the upper lip. In most patients, it fades to be virtually invisible within 6 to 12 months of surgery.
The scar heals along a fairly set course. For the first couple of weeks, it looks pink and sits a little raised. Come the three-month point, it has generally flattened and lost much of its colour, and by six months, most patients struggle to see it even up close. At a year, viewed in ordinary light from a normal conversational distance, it is rarely something anyone notices.
How well a scar settles comes down to a handful of things: your skin type, how much sun the area gets while it heals, how closely you follow the aftercare instructions, and whether you smoke. Dr Laniewski’s team talks patients through silicone scar gel and micropore taping. For patients with darker skin tones, the advice is adjusted to focus on sun protection and managing pigmentation, as this group may be more prone to post-inflammatory hyperpigmentation around a healing incision.
For the vast majority of patients considering open rhinoplasty for the right clinical reasons, the columellar scar is not a lasting concern. It is consistently one of the aspects of the procedure that patients report worrying about beforehand, but find unremarkable at their twelve-month review.
What Does the Research Say?
For patients who want to understand the evidence behind technique selection, the current literature is reassuring in a specific way.
A 2025 systematic review and meta-analysis by Nazarpour and colleagues (published in PubMed Central, PMC12327578) pooled data from twelve studies comparing open and closed rhinoplasty. The analysis found no statistically significant difference between the two techniques in patient-reported outcomes, including rhinoplasty outcome evaluation (ROE) scores and nasal obstruction symptom evaluation (NOSE) scores. Rates of postoperative swelling (oedema), bruising (ecchymosis), operative time, and overall patient satisfaction did not differ significantly between approaches across the included studies.
An earlier systematic review by Sinno and colleagues (PMC9507448), which looked at 143 cosmetic rhinoplasty patients across three studies, found that complications such as nostril scar contracture, supratip depression, and tip widening were reported only in the open subgroup. However, 78.4 percent of patients in that review reported satisfactory results overall, with no significant difference in satisfaction rates between the two techniques.
This research consistently shows that technique is one variable among several. Surgeon experience and volume with the chosen technique, surgical planning, and the match between approach and individual anatomy are all as important as the technique itself. Choosing a surgeon based on their experience and an honest assessment of what your nose needs is a better guide than selecting a technique based on a single feature, such as the presence or absence of a scar.
How Dr Laniewski Decides Which Technique to Use
Dr Peter Laniewski is a Specialist Plastic Surgeon (FRACS, AHPRA MED0001155003) with over 20 years of surgical experience. He performs both open and closed rhinoplasty and selects between them based on each patient’s nasal anatomy, their stated goals, and the degree of structural change involved.
The decision is made at consultation after a thorough assessment of the nose, including an internal examination to check the airway. Dr Laniewski discusses the reasoning with each patient so that the choice of technique is understood, not simply accepted. If a patient has a strong preference for closed rhinoplasty, that is a valid conversation to have. If the goals genuinely fall within what closed rhinoplasty can achieve well, it remains an option. If the level of change required would be better served by an open approach, Dr Laniewski will explain why.
Australia’s current AHPRA cosmetic surgery guidelines set out clear steps for cosmetic rhinoplasty. You will need a GP referral, two consultations, body image (BDD) screening, and a cooling-off period of at least seven days before any surgery is booked. For patients under 18, the requirements go further, adding an independent psychological assessment and a three-month cooling-off period. At Dr Laniewski’s practice these are part of the standard consultation process rather than optional extras.
To discuss your rhinoplasty goals with Dr Laniewski, contact our team to book your consultation.
Why Choose Dr Laniewski for Rhinoplasty in Sydney and Central Coast
Dr Peter Laniewski is a Specialist Plastic Surgeon (FRACS, AHPRA MED0001155003) with over 20 years of surgical training and practice across Sydney, the Central Coast and regional New South Wales. He holds specialist registration with AHPRA and is recognised by Australia’s three peak plastic surgery bodies.
- FRACS, Specialist Plastic Surgeon. Fellow of the Royal Australasian College of Surgeons. AHPRA registration MED0001155003, verifiable on the public AHPRA register.
- Member of three peak bodies. Australian Society of Plastic Surgeons (ASPS), Australasian Society of Aesthetic Plastic Surgeons (ASAPS), and Board Certified Plastic Surgeons of Australia.
- Over 20 years of surgical experience. Undergraduate medicine at the University of New South Wales, advanced training in General Surgery and Plastic and Reconstructive Surgery, and an international fellowship at the Royal Marsden Hospital in London.
- Sub-specialty training in facial and aesthetic surgery. Further training and courses in Harley Street (London), New York, Germany and France, with a focus on facial and breast aesthetics.
- Operates in accredited private hospitals. All rhinoplasty surgery is performed in fully accredited private hospital theatres in Sydney, the Central Coast and Albury, with specialist anaesthetists.
- Five consultation locations across NSW. Bella Vista (Sydney North-West), Woollahra (Sydney Eastern Suburbs), Erina (Central Coast), Narellan (Sydney South-West), and Albury (regional NSW / Victorian border).
- AHPRA-compliant cosmetic surgery process. All cosmetic rhinoplasty patients receive a GP referral, two consultations, body image (BDD) screening, and a minimum 7-day cooling-off period before surgery is booked, in line with current AHPRA cosmetic surgery guidelines.
To verify Dr Laniewski’s specialist registration, search ‘Peter Laniewski’ or registration MED0001155003 on the AHPRA Register of Practitioners. To book a rhinoplasty consultation, call 1300 322 337 or use the online enquiry form.
Surgeon profile: Dr Peter Laniewski on ASAPS | Dr Peter Laniewski on ASPS | Board Certified Plastic Surgeons of Australia
Frequently Asked Questions
Can I choose closed rhinoplasty if my surgeon recommends open?
You can raise this preference, and a good surgeon will discuss it with you. If your goals genuinely fall within the scope of what closed rhinoplasty can achieve safely and accurately, it may remain a reasonable option. If the structural changes needed are beyond what closed technique can reliably deliver, your surgeon will explain why open rhinoplasty is likely to give you a better result. The conversation is worth having at a consultation with your goals clearly on the table.
Does open rhinoplasty take longer to recover from?
Not really, for the vast majority of people. The same internal nasal structures are being worked on with either approach, so the swelling tends to settle on a similar timeline, and the columellar incision adds little to that. As a rough guide, most patients are back at a desk job inside one to two weeks, easing into light exercise around three to four weeks, and cleared for full activity by six weeks, whichever technique was chosen.
Is the columellar scar from open rhinoplasty noticeable in photos?
In most patients, no, not after the first several months. The scar sits on the underside of the nose and is not visible in a standard face-forward photograph. It may be faintly visible in close-up profile or three-quarter photos in the first few months, but by 6 to 12 months, it is typically not something most people notice. Consistent use of silicone scar gel and sun protection during recovery supports the best possible outcome.
Is closed rhinoplasty cheaper than open rhinoplasty?
Not automatically. The overall cost of rhinoplasty depends on the complexity of the surgical plan, theatre time, anaesthetic fees, and post-operative care, not on the presence or absence of a columellar incision. A simple closed rhinoplasty may have a shorter operative time than a complex open case, but the two are rarely directly comparable in scope. A detailed written quote is provided after consultation once the surgical plan is established.
Can closed rhinoplasty fix a deviated septum?
Septoplasty (the surgical correction of a deviated septum) can, in some cases, be performed through a closed approach. However, when a deviated septum is being addressed at the same time as significant cosmetic reshaping, combining the work as a septorhinoplasty under an open approach generally allows both components to be planned and executed together with greater precision, and avoids the need for two separate procedures.
Page authored and clinically reviewed by Dr Peter Laniewski, MBBS FRACS, Specialist Plastic Surgeon. AHPRA registration MED0001155003. Last clinically reviewed: 29/6/2026.
This page is for general information and does not replace a face-to-face consultation. All surgical procedures carry risks. For a personalised assessment, book a consultation with Dr Laniewski.
Further Reading
Rhinoplasty (Nose Job Surgery) Sydney – Dr Laniewski’s complete rhinoplasty procedure page, including technique overview, candidacy, costs and before-and-after photos.
Rhinoplasty Recovery: How to Reduce Swelling After Your Nose Surgery – A detailed guide to managing recovery and supporting healing after nose surgery.
How Much Does Rhinoplasty Cost in Sydney? – An overview of the factors that influence rhinoplasty fees in Sydney and what to expect from your quote.
How to Sleep After Rhinoplasty – Practical guidance on sleep positions and night-time habits that support healing after nose surgery.
Medical References
Nazarpour M et al. (2025). Outcomes of Open Versus Closed Rhinoplasty: A Systematic Review and Meta-analysis. PubMed Central PMC12327578.
Sinno H et al. Outcomes of Closed versus Open Rhinoplasty: A Systematic Review. PubMed Central PMC9507448.
Healthdirect Australia. Rhinoplasty (nose job). healthdirect.gov.au.
Australian Health Practitioner Regulation Agency (AHPRA). Cosmetic surgery guidelines. ahpra.gov.au.
Cleveland Clinic. Rhinoplasty (Nose Job): What It Is, Recovery and Results. my.clevelandclinic.org.
