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Scarless Nose

What Is Closed Rhinoplasty?

The size, shape, and position of the nose in relation to the rest of our facial features play an important role in our perceived attractiveness. For some, the appearance of the nose is a source of pride and confidence, but for others, it can be a reason for enhancement.

For the latter, a closed rhinoplasty (or a closed nose job) can help improve the look of the nose without visible scarring. If you’re considering getting a closed rhinoplasty, here’s what you need to know about this safe and popular procedure.

What is a closed rhinoplasty?

A rhinoplasty, also called a nasal augmentation, is a surgical procedure meant to change the shape, size, and appearance of the nose and the nostrils.

  • Open rhinoplasty (external rhinoplasty) requires general anesthesia, with the surgeon making a small incision on the patient’s columella, or the soft tissue separating the nostrils. This gives the surgeon access to the underlying bone and cartilage structure of the nose.

    The main advantage of an open rhinoplasty is that it allows for total reconstruction of the nose. It is also ideal for revision rhinoplasty since the original shape of the nose has already been modified. It allows total reconstruction from scratch, with the surgeon reshaping the nose into any structure desired.

  • Closed rhinoplasty (endonasal rhinoplasty) is also performed under general anesthesia but with all incisions made within the nostrils on the mucosa.The surgeon typically makes separate surgical openings in the left and right nostrils. It’s less invasive and causes less swelling compared with an open rhinoplasty. This procedure is recommended for primary rhinoplasty, or for patients who have not had rhinoplasty surgery performed on their nose.

    The main advantage of a closed rhinoplasty is that it does not alter the natural characteristics of the nose and simply refines and enhances the patients’ current anatomy. This approach allows for nose refinement without drastic changes, simply giving the patient a contoured version of their natural nose.

    Many patients do not want an overly surgical look that makes it obvious to their family or peers that they’ve undergone a rhinoplasty. For this reason, closed rhinoplasty is preferred as there are fewer tell-tale signs of surgery. Another advantage of closed rhinoplasty is that it doesn’t leave external cuts or scars.

Closed rhinoplasty: Bulbous tip, dorsal hump, and other cosmetic nasal issues

Closed rhinoplasty addresses common aesthetic nasal issues, including:

  • Nose size – If the size or width of your nose isn’t in proportion with the rest of your face, a closed rhinoplasty can refine and slim down your nose for overall facial balance.

    rhinoplasty before and after photo of a female patient with wide nasal bones

  • Nose shape – A closed nose job can enhance the shape of the nose, particularly for patients with wide nasal bones, bulbous or droopy tips, or asymmetrical noses. Click here for more information on nose shape and rhinoplasty.

    nose job before and after photo illustration of a female patient with large dorsal hump

  • Nose angle – The angle formed at the point where the nose and forehead meet, and from the nasion to the tip of the nose, can make your nose look short or long. Rhinoplasty will help create the ideal angle for your nose.

    Illustration of a male patient with droopy nose tip who underwent a closed rhinoplasty tip refinement

  • Nose bump – Dorsal humps are cartilage and bone irregularities that can distort the appearance of the nose. A rhinoplasty can help create a smoother nose bridge.

    closed rhinoplasty before and after photo of a female patient with small dorsal hump

A closed nose job can also address breathing issues. Your surgeon will assess nasal breathing during the consultation. If the surgeon detects an anatomical issue, such as a deviated septum or nasal valve collapse, they can discuss your options. Breathing issues can be addressed either independently via functional surgery or in conjunction with cosmetic nasal surgery.

How does closed rhinoplasty work?

The surgeon will make small incisions inside the nostrils and through the mucosa instead of the external part of the nose that is covered in skin so that there is no visible scarring. Through these small incisions, a highly skilled closed rhinoplasty surgeon is able to visualize the structures of the nose and shape them to the desired aesthetic result.

Once the operation is complete, the surgeon will close the incisions with dissolvable sutures, or dissolvable stitches. The surgeon will also place a small cast or splint over the nose to assist in healing.

A professional consultation is the key to understanding whether or not you are a good candidate for a closed nose job. If you are unsure whether you would be a better candidate for open or closed rhinoplasty, schedule a consultation with an honest physician who will guide you to the best option based on your natural nose shape and your desired outcome.

Closed rhinoplasty is also ideal for patients with breathing issues who require a septoplasty, a nasal reshaping procedure that involves straightening of the bones of the septum, in conjunction with cosmetic enhancements such as shaving of the nasal bridge, sculpting the nasal tip,, and lifting a droopy nasal tip.

Rhinoplasty is generally recommended for patients aged 15 and up. At this age, the facial skeleton is usually mature enough to undergo cosmetic changes. Another way for surgeons to determine whether or not the facial skeleton has fully developed is to understand when the patient’s foot size has stopped growing, since the growth of the foot correlates to the growth of the facial skeleton.

Open rhinoplasty by contrast is better suited for patients who need or desire complete nasal reconstruction. All rhinoplasty candidates are evaluated on a case-by-case basis. Schedule a consultation today to find out if you can safely undergo closed rhinoplasty.

What are the advantages of closed rhinoplasty?

Candidates may opt for closed rhinoplasty for a number of reasons, including:

  • Hidden incisions – An advantage of closed rhinoplasty is that all incisions are made inside the nose with no external cuts or scars, therefore there is no risk of permanent external scarring, which is often the case with open rhinoplasty and other procedures that involve external incisions.

  • No scarring – Patients who are concerned with potential scarring or keloids should consider getting closed rhinoplasty over open rhinoplasty, since the incisions are internal and no external incisions are made during the procedure.

  • Shorter surgery time – With open rhinoplasty, half the operating time is spent making external incisions, deconstructing the nose, and closing those incisions, which is why the procedure takes longer to complete. Closed rhinoplasty, by comparison, tends to have a shorter operating time because the nose is not being reconstructed from scratch.

  • Better circulation on the skin of the nasal tip – Generally speaking, patients experience less swelling after a closed rhinoplasty since the skin’s natural drainage channels remain largely undisturbed during surgery. This is because the columellar blood vessels remain undisturbed during the procedure whereas these blood vessels are cut during open rhinoplasty, which leads to decreased blood circulation to the nasal tip and causes more swelling.

  • Faster Recovery Time – Generally speaking, patients have a faster recovery period due to the internal incisions with no external cuts or scars to heal. Most patients are able to be back to socializing 7 days after surgery, once the cast is removed with little to no tell-tale signs of surgery.

If you have aesthetic reasons for undergoing closed rhinoplasty, bulbous tip reduction and dorsal hump removal are just some of the cosmetic benefits of the procedure.

What are the disadvantages of a closed rhinoplasty?

Like any surgical procedure, patient selection is of paramount importance. A thorough and honest consultation with a closed rhinoplasty surgeon will help you determine whether or not this technique is ideal for you. In our practice, 98% of patients say that they’re happy with the results, while the remaining 2% feel underwhelmed with the outcome as the worst case scenario.

Closed rhinoplasty comes with calculated risks that a trained surgeon can manage. This means that there is a much lower chance of getting a botched nose job with closed rhinoplasty, especially when performed by a skilled rhinoplasty surgeon who performs the procedure on a regular basis. Open rhinoplasty, on the other hand, poses a far greater risk when it comes to patients and surgeons “doing too much, too soon” in the worst case scenario, giving the nose a “botched” appearance.

But for some patients, an open rhinoplasty might be the better option depending on their natural anatomy, but this can only be discussed during a professional consultation. While the actual surgical maneuvers performed during open or closed rhinoplasty are the same, open rhinoplasty is different in that it allows for the total reconstruction of the nose. Think of it as remodeling versus rebuilding a home. If a home is good overall with excellent bones and structure, the new owner may decide to simply remodel the home, which is akin to getting a closed rhinoplasty. But if a home has complicated anatomy, tearing it down and rebuilding from scratch might be preferable, much akin to getting an open rhinoplasty.

In any case, it’s important for patients to verify that their surgeon is skilled and that they performed rhinoplasty multiple times. Moreover, it’s important for them to decide whether they agree with the surgeon’s aesthetic style and preferences. The best way to find out if you’re a good candidate for either open or closed rhinoplasty is to have an honest consultation with a board certified surgeon who will discuss the best procedure for your natural anatomy and desired outcome.

It’s important for candidates to choose a skilled and experienced surgeon when considering closed rhinoplasty. Dr. Deepak Dugar is the only Board Certified Rhinoplasty Surgeon in the United States whose practice is solely dedicated to Scarless Nose™ Surgery.

Closed Rhinoplasty Before and After

Getting ready for closed rhinoplasty: Before and after your surgery

What to do before surgery

Closed rhinoplasty is a safe and widely performed procedure, but the surgeon should make sure that the patient fully understands it by discussing their desired outcome prior to surgery.

The best way to evaluate a surgeon’s work is to look at real patients’ before and after closed rhinoplasty photos. Helping patients visualize the anticipated results of the procedure can make them feel more confident about going into surgery.

Try our FaceTouchUp Nose Morph tool for help visualizing any cosmetic changes to your own nose by playing around with your own anatomy. It is important to note that morphing technologies never can accurately predict final results so they should only be used as a conversation tool to identify the goals, but never to predict the final results.

To ensure a successful procedure, patients should follow these practices prior to surgery:

  • Avoid unprescribed medications – Your surgeon might advise against taking any OTC and non-prescription medications for about two weeks before the procedure to make sure that these do not interfere with the procedure and recovery.
  • Avoid smoking – When considering rhinoplasty, patients should be in good overall health and avoid smoking four weeks before and after surgery since smoking can potentially delay healing by vasoconstricting the blood vessels.
  • Limit sun exposure – Patients are advised to avoid prolonged or unprotected sun exposure for six weeks following rhinoplasty. Doctors recommend wearing SPF 30 or higher.
  • Avoid food or fluid intake – Patients must avoid eating or drinking as indicated by the surgeon or anesthesiologist based on the timing of your surgery.

Following your surgeon’s advice will help you prepare for surgery and ensure optimal results from your closed rhinoplasty.

What to do after surgery

Once surgery is complete, the patient must take measures to ensure proper healing:

  • Don’t drive after surgery – For your immediate safety, make arrangements to have someone take you home following the procedure while you wait for the anesthesia to wear off. You must have someone take care of you for 24 hours.
  • Don’t blow your nose – If there is blockage or drainage in your nose, you may gently sniff up, swallow or spit out any contents but do not blow your nose and try to clean the inside of your nose itself. If you must sneeze, try sneezing with an open mouth to help minimize any disturbance in the nose while it heals.
  • Eat a soft diet – Patients are generally advised to stick to cool and bland foods like plain crackers within the first 24 hours following a closed rhinoplasty. They are also advised to stick with soft foods like soup, oatmeal, mashed potatoes, or smoothies within the first few days of surgery while avoiding hot or spicy meals and beverages during this time.

Some surgeons will also advise patients to avoid foods that are difficult to chew within the first week of getting a rhinoplasty.

  • Must avoid heavy or strenuous activities – While recovering from surgery, avoid demanding physical activities like heavy lifting, strenuous exercise, or contact sports for at least six weeks to protect the surgical site and ensure that it heals properly.
  • Take your prescriptions – Any prescription medications to help with recovery and pain management will be provided by the day of the surgery. Take your prescriptions as directed.
  • Keep your cast clean/dry – Keep your cast clean and dry during recovery. You will be required to apply antibiotic ointment to your stitches using a q-tip or a clean, soft-tipped applicator to keep it moist.
  • Sleep on your back – Surgeons typically advise patients to sleep on their backs for at least one to six weeks while recovering from closed rhinoplasty. This will help keep the swelling more manageable and prevent any pressure to the nose.
  • Keep your head elevated – Place your head on two pillows to keep it elevated to help with swelling.
  • Use a toothbrush with soft bristles – Switch to a soft bristle toothbrush while recovering from closed rhinoplasty to ensure comfort. Avoid excessive movement or pressure to the upper lip.

Your surgeon will provide support and make sure that you have all the information you need for a timely recovery following closed rhinoplasty. It’s common practice for surgeons to set follow-up meetings with patients to discuss the results of the procedure.

Have peace of mind and look forward to the results when you work with a rhinoplasty specialist in Beverly Hills, CA. As a Board Certified surgeon with years of extensive practice, Dr. Deepak Dugar M.D. specializes in closed rhinoplasty to help patients feel more confident about their appearance.

His entire practice is devoted to Scarless Nose Surgery, making him the only Board Certified Rhinoplasty Surgeon in the United States to hold this distinction. When you work with Dr. Dugar, you work with a true expert who is passionate about helping clients make informed decisions.

Dr. Dugar believes that Patient Education is one of the most important aspects of closed rhinoplasty, which is why he welcomes patients to his Beverly Hills office for in-depth consultations. He puts patients at ease with his calm and affable nature, creating a relaxed and no-pressure atmosphere in which patients feel empowered to make their own decisions.

Our fully accredited and state licensed surgical facility in the Camden Medical Arts Building near Rodeo Drive allows us to provide the best quality care and treatment for rhinoplasty candidates. Our trained staff will provide the support you need for a seamless and successful rhinoplasty.

Meet with Dr. Deepak Dugar for Closed Rhinoplasty Consultation for any questions or concerns you might have about getting your nose done. You can schedule an appointment here. You can also contact us at 310.276.1703 and [email protected] for more information.


Author

Dr. Deepak Dugar

Director of Beverly Hills Rhinoplasty Center - Home of the Scarless Nose™ (Closed Rhinoplasty) Director of Scarless Med Spa