Closed rhinoplasty: the advantages of internal incisions

What is closed rhinoplasty? What are the differences between this technique and open septorhinoplasty? How much does closed rhinoplasty cost? Which of the two cosmetic surgeries gives better results? These and many other questions are asked by those who decide to undergo nasal surgery. Let us start with an initial definition of the closed rhinoplasty procedure.

In endonasal rhinoplasty, the surgeon works on the external and internal structures of the nose through the incisions made inside the nostrils. This technique has an obvious advantage: it leaves no visible scars on the nose. In fact, unlike the open surgical technique, internal rhinoplasty does not require any cut on the skin of the columella.

At the same time, a closed nose job is technically more complex as the surgeon operates in a limited visual field. He can rely on the sensibility of his touch, a very fine sense that gives him an immediate and continuous control of the changes he gradually performs on the various anatomical structures of the external nose. Thus, only the most skilled and experienced surgeons can perform an endonasal septorhinoplasty.

Closed rhinoplasty before and after

My Patients’ Journey with Me

Primary septorhinoplasty: open or closed technique?

Nowadays patients looking for primary rhinoplasty are very advanced and selective in their choice of a surgeon, They want to know just from the first visit which surgical technique, open or closed/endonasal, will be used by a surgeon. This curiosity is absolutely legitimate. The crucial difference between the two surgical approaches is that:

  • In open rhinoplasty, the surgeon makes an incision on the columella, the pillar of soft tissue and cartilage located between the two nostrils. To expose the cartilaginous and bony nasal pyramid to perform corrections he needs to lift a skin soft-tissue (SMAS) flap. It may require a vast area of dissection in this area till a complete degloving.
  • In closed rhinoplasty, the access to the whole cartilaginous and bony framework is executed through the different incisions within the nasal cavity. Obviously, this approach doesn’t leave no visible scars. They are all internal within the nose. This particular feature about this surgical technique explain why we also call this approach as internal or endonasal septorhinoplasty.

Let’s focus on the advantages and disadvantages of the endonasal rhinoplasty.

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Endonasal rhinoseptoplasty: advantages and disadvantages

The first and the most important benefit of the internal rhinoplasty is its’ reduced invasiveness compared to the open approach. The closed surgical procedure has a shorter operation time, which for its part, is an important element to reduce overall operative invasiveness: a significant issue so often neglected, as by surgeons, as by patients. Statistically closed/endonasal rhinoplasty demonstrates less dowmtime, which mean earlier socialization of the patient and return to the normal preoperative rhythm and style of life. Needless to say, that all these elements have an great impact on the patients’ quality of life. And these are the reasons also why many surgeons are abandoning the open approach in favor of the closed nose jobs.

In short, the advantages of endonasal procedure include:

  • Greater versatility: the surgeon can choose techniques depending on the defect to be corrected. This is a major difference from theopen rhinoplasty, where the standard approach is always the same, regardless of the patient’s anatomy;
  • Shorter operation times;
  • No risk of external scarring. Scars could be left only in case of contextual narrowing of the nostrils (therefore, the open technique could potentially leave a double scar);
  • Often more natural and predictable results;
  • Reduced postoperative swelling;
  • Faster recovery time and less downtime.
  • Possibility to use different incisions to reach the areas to be corrected. This increases safety and reduces the risk of serious complications in patients who have already undergone multiple surgeries – especially with the open technique. In addition, minimal invasive rhinoplasties put less stress on the outer covering skin, which is very often affected by the many previous procedures.

At the same time, this technique also has following disadvantages:

  • working on the nasal structures without a complete exposure is challenging from the technical point of view and requires advanced skills, precision, and experience;
  • the procedure may be not indicated for extreme rhinoseptoplasties and complex revisions (secondary rhinoplasty), which could need a complete exposure for reconstruction manoeuvres.

What patients are looking for in closed rhinoplasty?

Patients who looking for endonasal septorhinoplasty usually aimed fot a non-destructive and minimally invasive approach in nasal cosmetic surgery. Some of them are travel so fa to be operated by the surgeon specialized in endonasal rhinoplasty, who, like an artist, combines the skills of precise and meticulous sculpting giving a visual shape of invisible things with maximal awareness.

Assuming the equal surgical experience of the operating surgeon, the results of open or closed septorhinoplasties are indeed comparable. Except for previously operated noses and complex corrections, closed nose jobs generally produce more natural results. New hybrid nasal surgery technique is even more versatile and precise, as it combines the advantages and benefits from both closed/endonasal and open approaches.

However, it is only the surgeon responsibility and moral obligation to suggest the surgical technique which could provide the best result in rhinoplasty for each individual patient. And the surgeon should be professional and honest. A true expert in rhinoseptoplasty can reshape the profile with precision and delicacy, obtaining stable, natural, pleasant and harmonious results applying both surgical techniques.

How much do closed rhinoplasties cost in Milan?

An experienced surgeon can obtain a natural and pleasant result by integrating, combining and modifying different techniques. More than 25 years of exclusive and absolute dedication to nasal surgery have allowed Dr Pietro Palma to develop a philosophy in rhinoplasty and a surgical concept that combines the advantages of the open and closed approaches. Hybrid rhinoplasty, now in use for over a decade, met the expectations in rhinoplasty of many patients, minimizing complications and providing optimal post-operative recovery and low downtime.

Aesthetic surgeons should master all essential rhinoseptoplasty techniques, to be able to choose the one right approach appropriate to the anatomical features of the patients and his/her desires in rhinoplasty.Therefore, it is naïve to choose a surgeon who applies the only one single surgical philosophy that he advocates in his internet communications. It is far wiser to rely on someone who has mastered all techniques and can adapt them to the patient.

Likewise, it could be a mistake to choose a surgeon basing only on the cost. It doesn’t mean that the patient should not evaluate the economic aspect of a nasal surgery. However, the pricing differences are rarely so significant to justify the preference of one surgeon over another. In general, the cost of closed rhinoplasty in Milan can vary according to many factors, like structure, operation time and clinic facilities, complexity of the operation, experience of the surgical team etc. Our experience suggests to rely on the best and the most experienced and trusted professionals in choosing a right surgeon for your rhinoplasty. For more information on the cost of a nose job with the internal technique in Milan, do not hesitate to contact us.

Your surgeon for the closed nose job in Milan

Anyone considering the possibility of undergoing internal septorhinoplasty in Milan can contact Prof. Pietro Palma. In over 25 years of exclusive surgical activity as a nose specialist, the surgeon and his team have performed a large number of male and female rhinoplasties, various teenage rhinoplasties and countless revisions of varying complexity (including cases of extreme rhino-septoplasty).

Considered by many colleagues and patients as the best surgeon for primary and secondary rhinoplasty in Milan, Dr Pietro Palma offers one more surgical procedure above the classic approaches of the open or closed technique. Advanced and versatile, hybrid rhinoplasty allows to get natural results and secures minimal invasiveness.

Please keep in mind that sometimes the possible rhinoplasty result cannot satisfy the give the expectations. In some particular cases the rhinoplasty specialist dissuades the patient from undergoing the operation or gives his professional opinion on what can be obtain during the surgery and what is not achievable. each rhinoplasty has its limits and possibilities determined by the individual facial features and anatomical structures. State of the skin and sort tissue envelopment matters a lot in getting desirable result. We always advise our patients to reflect for a long time and carefully on the decision to get a nose job. From our side, as surgeons, we should first carefully and in a very detailed manner evaluate your anatomy and your desires in rhinoplasty in order to decide which technique should be applied to improve the aesthetics and functioning of your nose.

Connect with us

Pietro PALMA Chirurgo Rinoplastica



The aim of the first consultation is to make a correct diagnosis of your external and internal nose as well as to evaluate your past medical history. Specific nose-related symptoms will be evaluated by taking a thorough history, a nasendoscopy, and performing morphological analysis of the external nose. Finally, I will take professional quality photographs of your face and nose for detailed analysis.


The first consultation is not aimed to sell a product. It cannot be free of charge as it is a very specialized consultation lasting 30’-45’ by an international rhinoplasty expert using high tech-tools in a modern, comfortable and well equipped medical office.


As each case is different, a standard cost cannot apply. Costs are related to the extent of surgery and the duration of the operation. Within the first 48-72 hours of the first consultation, a detailed quotation will be emailed to you.


As your surgeon, I will adapt my technique to match your specific anatomical findings and with respect to your wish list of desirable changes. Due to my decades of dedicated rhinoplasty surgery, I can call upon a vast array of techniques in order to safely cope with the myriad variants of nasal anatomy.

I prefer closed (endonasal) rhinoplasty for most of my patients in order to be respectful of nasal anatomy and avoid unnecessary surgical aggressiveness. In more complex cases, I use an “hybrid” closed approach that allows me to utilize techniques commonly used in the open approach (sutures, grafts) but without opening the nose. I opt for the open approach in severe malformations or in specific revision cases.


The nose is a complex structure in which form and function are intimately connected. Almost always, rhinoplasty is a septo-rhinoplasty because the septum not only plays a functional role, but also contributes to common problems of the external nose. Examples include: crooked nose, hump, drooping tip, excessive nasal length, over-projection of the nasal tip, just to name a few of the common deformities seen in my practice.

Inferior turbinates are probably the commonest cause of nasal obstruction, and their treatment is commonly associated with septo-rhinoplasty or rhinoplasty. Modern, minimally invasive endoscopic techniques allow the surgeon to manage these important structures precisely and conservatively.
Therefore, it is absolutely indispensable that your rhinoplasty surgeon possesses specialist training and substantial experience in treating problems of the internal nose.

Follow us on Instagram and stay tuned!

I am happy to attend the Annual Meeting of the European Academy of Facial Plastic Surgery (EAFPS) to be held in Verona, September 14-17.🇮🇹
Every year a WORLD-RENOWNED surgeon and MENTOR is appointed to deliver the Joseph Lecture at the EAFPS Annual Meeting, in honour of Jacques Joseph (1865-1934), the father of rhinoplasty.

This year I have the HONOR and the PRIVELEGE to be the Joseph lecturer.

It happens ONCE in a life time.

🔷 I will share my experience as well as the ideas that I have developed in my LONG RHINOPLASTY JOURNEY shared with thousands of patients.
- visual distractors,
- hybrid route,
- multiportal approach,
- aesthetic subunits of the nose,
- analytical/surgical focus on nasal surface and contours will be explained in details.
🔷 I aim to the NEXT LEVEL of results while REDUCING surgical invasiveness.

🔹 I thank my PATIENTS wholeheartedly for their trust.
🔹 I thank my MENTOR Prof. Giorgio Sulsenti.
🔹 I thank my dearest FRIEND , Prof. Paolo Castelnuovo.
🔹 I thank the many COLLEAGUES that have been teachers and role models.
🔹 I thank my FAMILY for giving me strength and love to pursue such a passionating professional path.

#eafps #eafps2023 #josephlecture #rhinoplasty #rhinoplastymentor #rhinoplastyexpert #rinoplastica #rinoplasticamilano #rhinoplastyitaly #hybridrhinoplasty #closedrhinoplasty #rinoplasticaibrida #rinoplasticachiusa #youniquerhinoplasty #pietropalma

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🎤I'm a SPEAKER at the 46th annual meeting of the EAFPS (European Academy of Facial Plastic Surgery) in Verona.
The meeting is just around the corner.
📌Mark your agenda and JOIN US for the ONLY ONE and UNIQUE session of this meeting where we'll talk about PROFESSIONAL but NOT TECHNICAL aspects that are essential for each of us.
Are you curious?
➡️Follow me and in the coming days I'll reveal a secret.
Beautiful and romantic Verona, where surgery meets beauty, is waiting for us!

#eafps #eafps2023 #eafpsannualmeeting #womeninsurgery #YOUniqueRhinoplasty #verona

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