When it comes to rhinoplasty, there are numerous techniques and there is usually never one right method. Every plastic surgeon has his/her own rhinoplasty techniques and preferences. In addition, there are advantages and disadvantages to every method.
Open vs. Closed Rhinoplasty
A key distinction in rhinoplasty is how the surgeon accesses the nasal structures.
Open (External) Rhinoplasty involves a small incision on the columella (the skin between the nostrils), allowing for enhanced visibility and precision. This is especially useful in complex or revision cases. While swelling may be slightly more pronounced post-operatively, the external scar is typically minimal and well-concealed with meticulous suturing.
Closed (Endonasal) Rhinoplasty uses incisions hidden inside the nostrils. This approach can offer less swelling, a quicker recovery, and no visible scarring. However, it limits visibility and access, which can be a consideration depending on the complexity of the case.
Traditional Reductive vs. Structural Rhinoplasty
Historically, many rhinoplasties were performed using a reductive approach, which focused primarily on removing excess cartilage and bone to make the nose smaller or straighter. While this method could produce significant changes, it sometimes compromised structural support, leading to issues like nasal collapse, breathing difficulties, or unnatural contours over time—especially as the nose continued to heal and age.
In contrast, Structural Rhinoplasty represents a more modern, reconstructive philosophy. Instead of simply removing tissue, it involves reshaping and reinforcing the nasal framework—often using cartilage grafts—to maintain both function and aesthetics. This technique is particularly beneficial for patients seeking long-term stability, natural contours, and improved nasal breathing. It also tends to offer more predictable results, especially in complex or revision cases.
Choosing the Right Approach
In the end, the “best” rhinoplasty technique is the one that aligns with your goals, supports your anatomy, and is executed with precision by a surgeon you trust. A personalized consultation is the first step in determining which approach is right for you.
Because nasal aesthetics are highly individual and outcomes are subjective, communication between you and your surgeon is critical. One of the most helpful tools in the planning process is morphing—digitally simulating your desired outcome based on photographs of your nose. This visual aid helps ensure you and your surgeon are aligned on your aesthetic goals and sets a foundation for a customized surgical plan.
Dr. Foulad most often performs rhinoplasty using the external approach, as it offers superior visualization and greater precision throughout the procedure. He also incorporates structural rhinoplasty techniques to ensure the nose is not only aesthetically refined but also well-supported for long-term stability and function.
