Daniel Demesh FPS

Closed Rhinoplasty

Closed Rhinoplasty Photo

Closed rhinoplasty or endonasal rhinoplasty refers to the surgical approach for rhinoplasty, where the incision is placed on the inside of the nose. This is done so there are no external incisions that can be viewed by the surgeon or the casual observer.  This approach is selected for patients who need only moderate work done with the goal to achieve facial harmony by changing the shape, size, or angle of the nose.  This may include changes to the nasal cartilage, bone, and septum.

Differences Between Open Rhinoplasty and Closed Rhinoplasty

The major difference between an open and closed rhinoplasty is where the incision is placed. For closed rhinoplasty, the incision is placed on the inside of the nose and for open rhinoplasty, the incision extends from the inner margins of the nostrils and crosses the columella (the external undersurface of the nose).

human nose anatomy

Where an open rhinoplasty approach is selected for patients who require the addition of cartilage and significant manipulation of the shape of the nose, a closed rhinoplasty approach is selected for patients who require less manipulation.

Advantages of a Closed Rhinoplasty

Because the nasal tip is not touched during a closed procedure, patients will have better circulation to the skin of the nasal tip and heal faster compared to patients who undergo an open procedure. Other added benefits include

  • There is no scar.
  • There is less swelling during the recovery period.
  • There is a decreased recovery period, usually within 5-6 days.
  • The cost is less for a closed procedure because it can be performed in half the operative time. 

Rhinoplasty Overview

According to a 2017 statistics report from the American Society of Plastic Surgeons, rhinoplasty (nose reshaping) is the third most requested cosmetic surgical procedure. It is a surgical procedure to reshape the nose. During surgery, the bone and cartilage are reshaped, but not the skin of the nose. When the underlying structures are changed, the skin conforms to the new shape of the nose.

Patients may choose to have a rhinoplasty done for either aesthetic or functional purposes.

Cosmetic Rhinoplasty

The goal for cosmetic rhinoplasty (aesthetic) is to create facial balance and patients may choose to correct the

  • Nose size in relation to facial balance
  • Nose width at the bridge or in the size and position of the nostrils
  • Nose profile with visible humps or depressions on the bridge
  • Nasal tip asymmetry

Functional Rhinoplasty

The goal for functional rhinoplasty is to correct impaired breathing that may have been caused by a structural defect in the nose, such as a deviated septum or trauma. Rhinoplasty to correct a deviated septum requires careful evaluation of the nasal structure as it relates to airflow and breathing. The surgery adjusts the nasal structure to produce a better alignment that restores function, eliminating the obstructed airway, and improving airflow and breathing.

Limitation to Rhinoplasty

While rhinoplasty can produce amazing improvement in the overall appearance of a person, there are limitations as to what can be achieved with the surgery. Sometimes there are technical limitations such as the overall size, shape, and skin of the nose, that may limit what can be achieved in surgery. For example, it wouldn’t be advisable to thin the nose so dramatically as it would sacrifice breathing.

Ideal Candidate for Rhinoplasty Surgery

You may be a good candidate for rhinoplasty if

  • Your facial growth is complete
  • You are physically and mentally healthy
  • You have a positive outlook and realistic goals in mind for the improvement of your appearance

Age Limits for Rhinoplasty Surgery

Rhinoplasty is not recommended for females until puberty is complete and the nasal anatomy is not expected to change or grow appreciably, usually around the age of 15 for females or the age of 16 for males. This, however, is a guideline and doesn’t dismiss the need for minor rhinoplasties or the correction of certain functional problems at an earlier age.

Careful assessment of the younger patient is stressed to determine maturity and motivation. Any decision to undergo such surgery should come from the patient and not from social or parental pressure.

Benefits of Rhinoplasty Surgery

The benefits of rhinoplasty surgery vary per patient. For some, the benefit of rhinoplasty surgery is purely functional where an airway obstruction has been eliminated and has improved the patient’s breathing. For others, the benefit may be purely cosmetic where the result offers the patient a new social identity after surgery.

Rhinoplasty Consultation

During your rhinoplasty consultation, you will be asked specific questions about your general health status and if you have any pre-existing health conditions or risk factors, such as

  • Do you have any medical conditions or drug allergies?
  • Have you had any previous medical treatments?
  • What current medications do you take, including vitamins and herbal supplements?
  • Do you currently or have you ever smoked?
  • Do you drink alcohol? If so, how much per day or per week?
  • Have you or do you currently use drugs?
  • What previous surgeries have you had, if any?

It is very important that Dr. Demesh has a clear understanding of your past medical and social history, so please be honest with your answers.

If you are interested in having aesthetic rhinoplasty surgery, Dr. Demesh may ask you what you dislike about your nose, the correction you desire, and your motivation for having the surgery.

Additionally, Dr. Demesh will discuss with you 

  • Your surgical goals with regard to both appearance and breathing.
  • Your options for nose reshaping. 
  • Your recommended course of treatment.
  • Your likely outcomes of nose surgery and any risks or potential complications.

Dr. Demesh will also

  • Examine and measure your face, including aesthetic analysis of the nose.
  • Take photographs for preoperative analysis and planning of the procedure.
  • Perform computer imaging of proposed changes to the appearance of your nose.

The aesthetic analysis of the nose is very important to define external nasal deformities, predict underlying anatomic variations, and determine appropriate surgical intervention. A thorough analysis includes observation, inspection, and palpation so that all details are considered.

This review of your medical and social history, along with a preoperative analysis will help Dr. Demesh determine if the deformity can be corrected, should be corrected, and if the correction has the potential to cause any nasal obstruction.

If Dr. Demesh determines, after careful analysis, that you are a candidate for rhinoplasty surgery, this is the time to have any of your own questions answered as well. From there, Dr. Demesh will work with you to formulate a surgical plan that will clearly delineate what you may or may not expect from surgery.

Medical Tests Required

An endoscopy may be performed with a small endoscope to examine the inside of your nose. If Dr. Demesh finds any clinical evidence of sinus disease, computed tomography (CT scan) may be ordered to rule out sinus pathology.

Second Preoperative Consultation

If there are any questions following the initial consultation, or there is a prolonged period before surgery is scheduled, it is preferable to have a second pre-operative consultation before surgery to confirm or modify the initial surgical goal.

Risks and Complications of Rhinoplasty Surgery

The risks of rhinoplasty surgery may include

  • Anesthesia risks
  • Infection
  • Poor wound healing and scarring
  • Change in skin sensation (numbness or pain)
  • Visible irregularities
  • Asymmetries, asymmetric nostrils
  • Nasal septal perforation
  • Cerebrospinal fluid leak
  • Decreased sense of smell
  • Difficulty breathing through the nose
  • Skin discoloration and swelling
  • Results of surgery differing from the simulated outcome
  • The eventual necessity of a revision rhinoplasty surgery

Before surgery, you will be asked to sign an Informed Consent, to ensure that you fully understand the procedure and any risks or potential complications as identified above.

The Rhinoplasty Procedure

Rhinoplasty surgery includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. In most cases, general anesthesia is preferable and may actually be safer. Dr. Demesh will recommend the best choice for you.

Step 2 – The Incision

For the endonasal (closed) rhinoplasty approach, two incisions are made within the inside of the nose to open the skin of the nose. Through these incisions, the skin and soft tissue that covers the nasal bones and cartilages are gently raised, allowing access to reshape the structure of the nose.

Step 3 – Reshaping The Nose Structure

An overly large nose may be reduced by removing bone or cartilage. Often, surgery of the nose may require the addition of cartilage grafts.

Most commonly, cartilage from the septum, the partition in the middle of the nose, is used for this purpose. Cartilage from the ear and/or a section of rib cartilage can be used in some cases as well.

Step 4 – Correcting A Deviated Septum

If the septum is deviated, it can be straightened and the projections inside the nose reduced to improve breathing.

Step 5 – Closing The Incision

Once the underlying structure of the nose is sculpted to the desired shape, nasal skin and tissue are redraped and the incision is closed.

Additional incisions may be placed in the natural creases of the nostrils to alter their size.

Step 6 – See The Results

For a few days, internal and external splints may support the nose as it begins to heal. Dr. Demesh does not routinely use packing inside the nose, allowing for nasal breathing during the recovery period.

What To Expect After Endonasal Rhinoplasty Surgery

During surgery, thin splints may be placed inside your nose and a splint or bandages placed on the outside to support and protect the new structures during initial healing.

You may also experience minor bleeding, swelling, and bruising on the nose and under the eyes, along with an achy feeling and slight headache for the first few days. This is normal. These symptoms will gradually disappear over the first week.

You may take Tylenol and over-the-counter pain medications to relieve any pain and discomfort.

Swelling may come and go and worsen in the morning initially with continued improvement during the first year following your rhinoplasty surgery.

You will be given specific instructions that may include:

  • How to care for the surgical site
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with Dr. Demesh

Rhinoplasty FAQs

While initial swelling subsides within 5-6 days, it may take up to a year for your new nasal contour to refine fully. During this time you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.

Rhinoplasty results are permanent, as long as you follow all aftercare instructions and avoid an injury that could alter the appearance of your nose.

Incisions are placed within the nasal passages so that they are not visible after surgery. During your consultation, Dr. Demesh will explain in detail where sutures will be placed.

You may resume light exercise within 3 weeks after surgery, and more strenuous exercise over the next 3 weeks. You should avoid any activities that could cause nasal trauma for up to 6 weeks.

Typically, patients can return to work within a week after surgery.

Stitches are normally removed within 1 week after surgery.

General anesthesia is used for closed rhinoplasty surgery.

The length of time for rhinoplasty surgery is different for every patient due to the extent of each individual surgery. Dr. Demesh will discuss this more in-depth with you during your consultation.

Rhinoplasty may be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center, or a hospital.

Functional rhinoplasty may be covered by health insurance, as the procedure is being performed to improve breathing function due to an obstructed airway. This procedure, whether performed alone or in conjunction with cosmetic rhinoplasty, is considered reconstructive and may be covered by insurance.


This requires a detailed examination to verify the cause of your breathing impairment and prior authorization from your insurer.

Yes, Dr. Demesh Facial Plastic Surgery offers financing options, including CareCredit. We also accept Health Savings Account (HSA) and Flexible Spending Account (FSA) debit cards for qualifying medical expenses.

Closed rhinoplasty costs vary but often include

 

  • Anesthesia fees
  • Hospital or surgical facility costs
  • Medical tests
  • Prescription for medication
  • Surgeon’s fee

A surgeon’s fee is often based on experience, the type of procedure used, and the geographic office location.

Contact Us

If you are interested in discussing closed (endonasal) rhinoplasty surgery with Dr. Demesh, please call (203) 712-7579 to set up a consultation.