Procedure explanation
Direct to camera
Why this practice opens most rhinoplasties instead of working through the nostrils
Draft body, not yet adapted
A closed rhinoplasty works entirely through incisions inside the nostrils. An open rhinoplasty adds a small incision across the columella, the strip of skin between the nostrils, and lifts the soft tissue off the framework so the surgeon can see it. The tradeoff is a scar of about four millimetres and slightly longer swelling. What it buys is direct vision of the lower lateral cartilages and the ability to place and suture grafts under load, watching what each one does. When the operation is mostly reduction, closed is often the right choice and the scar is not worth paying for. When the operation is structural, when support has to be rebuilt rather than removed, working blind through a nostril means guessing at the geometry. Dr. Ashford opens roughly four out of five primary cases for that reason, and says so at the consultation along with what the scar looks like at one year. The literature does not show a difference in long-term appearance between the two approaches, which is exactly why the choice should be made on what the individual nose needs.
Call to action. The full anatomy lecture this is drawn from is on the YouTube channel.