Open rhinoplasty

What is open rhinoplasty?

Open rhinoplasty is a nose operation in which the surgeon makes a small incision across the columella — the narrow strip of skin between the nostrils — and joins it to incisions inside the nose. The skin of the lower nose can then be lifted like a hood, so the surgeon sees the cartilages and the septum directly instead of working through the nostrils. The result is not a different kind of nose: the same hump reduction, narrowing and tip work can be done. What changes is how much the surgeon can see and control, and that matters most for noses that need precise structural work.

This page is about the open approach only — when it is needed, the scar, the recovery and the price. For the full guide to a nose job in Turkey, including the trip, packages and choosing a surgeon, see rhinoplasty in Turkey. If you hope to avoid any external scar, read about closed rhinoplasty and its limits.

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When is open rhinoplasty needed?

Surgeons do not choose the open approach for a bigger result but for better access. It is usually recommended when:

• The tip needs real reshaping: a wide, bulbous, asymmetric or drooping tip where the cartilages have to be trimmed, repositioned and stitched in a symmetrical way. Seeing both sides of the tip at once makes symmetry easier to judge. See also bulbous nose rhinoplasty and tip rhinoplasty.
• The nose is crooked: a twisted bridge or a deviated septum near the front of the nose often needs cartilage grafts and stitching that are more reliable under direct view. A septoplasty is usually part of the same operation.
• Grafts are needed: spreader grafts that keep the airway open after a hump is removed, a strut that supports the tip, or cartilage from the ear or rib when the septum does not provide enough.
• It is a revision: after a previous nose job the anatomy is scarred and unpredictable, so most revision rhinoplasty is done open.
• The skin is thick or the bridge needs building up: in many ethnic rhinoplasty cases the tip needs strong support and the bridge needs grafting, which the open approach makes easier.
• Breathing has to be fixed as well: a collapsing nasal valve or a severely deviated front septum is easier to rebuild open.

For a nose with a hump, a reasonably straight shape and a tip that needs only modest changes, an open approach is often not necessary. A surgeon who suggests open surgery should be able to tell you which of the reasons above applies to your nose.

Open vs closed rhinoplasty: the differences

Open or closed rhinoplasty is one of the first questions patients ask. Neither approach is better for every nose; each suits different problems. Published comparisons have not shown that one approach gives better results for all patients when each is used for the right nose.

The approach is a means, not an aim. What decides the result is whether the plan fits your nose and how experienced the surgeon is with that plan. The closed rhinoplasty guide explains who suits the scarless approach and where it reaches its limits.

Open rhinoplasty scarring: what the columella scar looks like

The incision is usually made in a small inverted-V or stair-step shape across the narrowest part of the columella. The shape helps the edges line up and makes the healed line less noticeable than a straight cut. It is closed with very fine stitches, which are removed after about a week, at the same visit when the splint comes off.

• First weeks: the line is pink and can be seen when someone looks up from below.
• Two to six months: it fades and flattens. Most people do not notice it at conversation distance.
• After a year: it is usually a fine pale line that is hard to find. Patient surveys published in plastic surgery journals report that most patients rate the columellar scar as inconspicuous.

The scar can be more visible in skin that tends to form thick or dark scars, in smokers and when the wound is under tension or becomes infected. You help it heal by not smoking, keeping the area clean as instructed, protecting it from the sun with a high-factor sunscreen for several months and not picking at crusts. Notching or a visible step in the columella is uncommon and can usually be corrected with a minor procedure. If the nostrils are narrowed at the same time (alar base reduction), there are separate small scars in the creases beside the nostrils — with open and closed rhinoplasty alike.

The open rhinoplasty procedure, step by step

Open rhinoplasty is done under general anaesthesia in a hospital, and most patients stay one night.

• Incisions: the small columella incision is joined to incisions along the inner edges of the nostrils.
• Lifting the skin: the skin and soft tissue are raised over the cartilages and the bridge, exposing the whole framework.
• Septum: a deviated septum is straightened; septal cartilage is often taken for grafts, leaving enough to support the nose.
• Bridge and bones: the hump is reduced and the nasal bones narrowed or straightened, with chisels, a fine saw or ultrasonic (piezo) instruments. Spreader grafts or flaps keep the middle of the nose and the airway open.
• Tip: the tip cartilages are trimmed, stitched and supported, often with a strut or extension graft, to set tip shape, projection and rotation.
• Closure: the skin is laid back, the columella is closed with fine stitches, soft splints may be placed inside the nose and a splint is fixed outside.

The operation usually takes about two and a half to four hours, longer for revision or rib cartilage grafts.

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Open rhinoplasty cost in Turkey

Hospitals in Turkey usually price rhinoplasty by the complexity of the plan rather than by the approach, so an open rhinoplasty falls within the same range as the main operation; rhinoplasty at the hospitals on our site starts at €2,890. The live prices of each hospital are on the rhinoplasty page. Open surgery tends to sit at the upper end because the cases that need it — grafts, crooked noses, revisions — take longer.

The figures outside Turkey are approximate private-sector totals and vary widely by clinic and city. What raises the price of an open rhinoplasty: a septoplasty or turbinate reduction for breathing, cartilage taken from the ear or rib, a revision, and extra hotel nights. Ask for the plan and every item in writing before you travel.

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Recovery after open rhinoplasty

Recovery follows the general rhinoplasty timeline described in the main guide, with a few points that are typical of the open approach:

• Days 1–7: swelling, bruising around the eyes and a blocked nose. The columella stitches and the splint come off around day 7, and then you can fly home if the surgeon agrees.
• Weeks 2–6: most people go back to work after about two weeks. The tip feels stiff and numb; no glasses on the bridge, no nose-blowing and no contact sport until allowed.
• Months 2–6: the bridge shape becomes clear, but the tip still looks fuller, particularly in the morning.
• Months 6–18: the tip refines slowly. Swelling of the tip lasts longer after open surgery because the skin was lifted and its small lymph vessels need time to recover; with thick skin it can take up to 18 months.

Feeling usually returns to the tip over several months. Taping the nose at night or steroid injections into persistent swelling of thick skin are sometimes used, only on the surgeon's advice.

Risks of open rhinoplasty

The risks are those of any rhinoplasty — bleeding, infection, breathing problems, irregularities and the need for a revision, which published studies put at roughly 5–15 in 100 primary rhinoplasties. The approach adds a few specific points:

• Columella scar: usually inconspicuous, but it can be visible, notched or wider in some skin types.
• Longer tip swelling and numbness, as described above.
• Skin healing problems over the tip: rare, more likely in smokers and in revisions with thin or scarred skin, which is why surgeons insist on stopping smoking.
• Longer anaesthesia: open operations take longer, which matters for patients with health conditions.

The UK's NHS and the American Society of Plastic Surgeons list the same main risks for rhinoplasty in general. You lower them by choosing a surgeon who does structural rhinoplasty routinely, having it in a hospital with an anaesthesiologist present, not smoking and following the aftercare.

Questions to ask before an open rhinoplasty

• Why do I need the open approach — which part of my nose cannot be done closed?
• Will you use grafts, and from where: septum, ear or rib?
• How will you protect my breathing, and is a septoplasty part of the plan?
• Can I see before-and-after photos of open rhinoplasty on noses like mine, including the columella from below, at least a year after surgery?
• Is the price in the quote final, and what would a revision cost?

The surgeons who perform rhinoplasty at our partner hospitals are listed on this page with their experience and reviews; you can also browse plastic surgeons and hospitals for plastic surgery, or read how it works.

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Hospitals with Plastic & Aesthetic Surgery in Turkey

Academic Hospital

Üsküdar, Istanbul

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Lokman Hekim Istanbul Hospital

Pendik, Istanbul

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