Closed Rhinoplasty London

Closed rhinoplasty, also called endonasal rhinoplasty or scarless rhinoplasty, is nose surgery performed entirely through incisions made inside the nostrils. Nothing is cut on the outside of the nose. Through those internal incisions the surgeon can reduce a dorsal hump, narrow or straighten the nasal bones, work on the septum and make measured changes to the tip cartilages, then close the incisions with dissolvable stitches that sit out of sight.

The alternative is open rhinoplasty, which adds one small incision across the columella, the strip of skin between the nostrils. That incision lets the skin of the lower nose be lifted back so the cartilage framework can be seen directly. Both are full rhinoplasty operations; the difference is how the surgeon reaches the structures, not how much can be changed in principle. In practice the access does change what can be done precisely, and that is the whole decision.

• Scar: closed leaves no external scar. Open leaves a short line under the columella that in most patients settles over several months into a fine pale line, though scars do vary and a few stay more visible.
• Visibility: open lets the surgeon see the tip cartilages in their natural position and measure them side by side. Closed works through a narrower window, so the tip is judged partly by feel and by delivering cartilage out through the nostril.
• Tip control and grafting: open gives more control for complex tip reshaping, asymmetry, and placing and securing cartilage grafts. Closed suits simpler, conservative tip refinement.
• Swelling: because the skin of the tip is not lifted in closed surgery, tip swelling often settles somewhat sooner. The bridge heals on a similar timeline with either approach, and the bruising comes mainly from any work on the bones, not from the choice of incision.
• Operating time: closed is often a little shorter, though in the hands of an experienced surgeon the difference is modest.
• Outcomes: when each approach is matched to the right nose, the published evidence shows no significant difference in breathing or satisfaction scores (see below).

Closed rhinoplasty tends to suit noses where most of the change is in the upper two thirds, and where the tip needs little or only straightforward work. Typical examples from my clinic:

• A dorsal hump on a nose whose tip is already well shaped (more on the dorsal hump page)
• A wide or slightly crooked bony bridge that needs narrowing or straightening
• Modest tip refinement in a tip with good support and reasonable symmetry
• Preservation-style hump surgery, where the bridge is lowered as a unit rather than shaved, which is commonly done through closed access (see what is preservation rhinoplasty)

It is usually the wrong choice for a markedly asymmetric or under-supported tip, a nose that needs several cartilage grafts, a badly twisted septum at the front of the nose, and most revision rhinoplasty, where scar tissue and altered anatomy make direct vision far more important than the absence of a small scar.

The main downside is less visibility. Because the skin is not lifted, the surgeon works on the bone and cartilage through a narrow window, and changes to the nasal tip are partly judged by feel. That makes the technique less appropriate for complex tip reshaping, for cases that need several grafts, and for most revision surgery.

The second downside is that the absence of scarring is sometimes sold as the main benefit, and the main reason to choose it. A closed nose job is still a full rhinoplasty procedure that involves the same nasal structures, the same anaesthetic and the same healing process; avoiding a small, well-hidden scar is a poor reason to accept a less precise result. Many patients who come to see us want to know which type of surgery will help them most, and the honest answer is that it varies, depending on the nose and the face it sits on rather than on the approach itself. Whoever you see, your surgeon should be able to explain without hesitation why they would take one route or the other for your nose. Like any cosmetic surgery, it is a decision for the patient to make with full information.

Most of my rhinoplasty surgery uses the open approach, because for most primary and revision noses the precision it allows matters more than a scar that, in most patients, fades until it is barely noticeable. Where the work allows, I perform closed rhinoplasty, with every incision hidden inside the nostrils. The choice is made per nose, never per habit, and never because one approach is easier to market.

At consultation I examine the outside and inside of the nose, assess tip support, cartilage strength, skin thickness and the septum, and go through your goals on photographs. Then I tell you which approach I would use and why. If you would strongly prefer closed surgery, we discuss honestly whether your nose allows it; if it does not, I will explain what would be compromised rather than agree and accept a lesser result.

A 2025 systematic review and meta-analysis of 1,067 patients comparing open and closed rhinoplasty found no significant difference in either functional outcome, measured with the NOSE breathing score, or aesthetic outcome, measured with the ROE satisfaction score (Abi Zeid Daou et al., 2025). Both techniques are effective when matched to the patient's anatomy.

That finding is worth reading carefully. It does not say the approaches are interchangeable for every nose; the patients in those studies were allocated by surgeons choosing the approach that suited them. What it does say is that a surgeon who chooses well can expect good results either way, which is why I treat the approach as a means, not a selling point.

Closed rhinoplasty is performed under general anaesthetic as a day case at Weymouth Street Hospital, with an anaesthetist looking after you throughout. You come in on the morning of surgery and go home the same day with an adult to collect you.

• The first week: a splint on the bridge if bone work was done, a blocked feeling, and bruising around the eyes that depends mainly on whether the bones were narrowed. Sleep with the head raised and don't blow your nose for two weeks.
• Day 7: the splint comes off. There are no external stitches to remove; the internal ones dissolve.
• Weeks 2 to 6: most patients are back at desk work and presentable by about two weeks. Cardiovascular exercise from four weeks, contact sport after six to eight weeks.
• Months 3 to 18: residual swelling clears, the tip last of all. The final result shows by around 12 months, longer with thick skin.

The full timeline, with what helps and what does not, is in the rhinoplasty recovery guide.

A nose has to work as well as look right, and this is where being an ENT surgeon as well as a facial plastic surgeon matters. Reducing a hump or narrowing a bridge through any approach can narrow the internal nasal valve if the supporting structures are not respected, leaving a nose that looks better and breathes worse. I examine the airway and septum at every consultation, and where the septum is deviated the operation becomes a septorhinoplasty, which can often still be done closed when the deviation lies further back in the nose.