Endonasal Rhinoplasty

Dr. Philip Miller

July 28, 2022

Dr. Miller never uses a “cookie-cutter” or one-size-fits-all approach to nose surgery. Because every patient is unique in their facial features, your consultation will determine which surgical approach is best for your particular circumstances. Double board-certified facial plastic surgeon Philip J. Miller, MD, FACS, performs both closed rhinoplasty (endonasal) or open rhinoplasty depending on the specific needs of each patient. 

Dr. Miller offers patients in Manhattan, New York, and New Orleans, Louisiana, expert rhinoplasty techniques, with the goal of bringing balance to your facial features and achieving beautiful, natural-looking results. 

What is endonasal rhinoplasty?

Also called a closed rhinoplasty, endonasal rhinoplasty is an internal procedure in which all incisions are confined to inside the nostrils. The nose is not opened fully, and the nasal structure is not exposed. The work is done entirely through narrow openings in each nostril. Patients concerned about visible scarring need not worry with a closed rhinoplasty. During the procedure, Dr. Miller carefully lifts the underlying bone, cartilage, and tissue through the nostrils, so you won’t be able to see any scarring.

Open vs. Closed Rhinoplasty

While both open and close rhinoplasty procedures can achieve exceptional results, each has its own advantages and drawbacks to consider during your consultation.

During an open rhinoplasty, Dr. Miller makes a small incision in the columella – the piece of tissue that separates the nostrils at the base of the nose. Also called external rhinoplasty, this technique opens the tip of the nose to reveal the internal structure. Dr. Miller can reshape the nose and repair damage while keeping structural support intact. An open rhinoplasty provides improved precision, enhanced visibility, and enhanced structural support. However, there can be minor scarring under the base of the nose. An open rhinoplasty may also require a slightly longer recovery process compared to a closed technique.

Dr. Miller typically recommends open rhinoplasties for patients with complex structural concerns, such as a severely crooked nose, nasal trauma or deformities, an asymmetrical tip, a large nasal tip, or a large dorsal hump (bump on the nasal bridge). For these patients, the possibility of a nearly imperceptible scar is a good trade-off for the most natural nose reshaping possible.

A closed rhinoplasty is especially appealing for those who want to make minor modifications to their nose. Dr. Miller might also recommend this approach if you have breathing problems, such as chronic sinusitis. It is a more conservative type of rhinoplasty, which means it may not produce the more dramatic results achieved with an open rhinoplasty. 

The closed technique is ideal for minor adjustments to the nasal tip and bridge. If you have a dorsal hump, wide nasal bridge, or enlarged nasal tip, endonasal rhinoplasty can deliver subtle results with little impact on the surrounding tissue.

Benefits of Endonasal Rhinoplasty

Because all stitches are located inside the nose, patients will not have any visible scarring after the surgery. Recovery may also be a bit faster, with many patients returning to work and other activities within one week rather than the two weeks usually allotted for open rhinoplasty recovery. Other benefits include:

• Decreased operative times
• Profile adjustments are easier to judge because the structural support remains undisturbed
• Reduced postoperative edema
• Quicker return to a normal appearance

How is Endonasal Rhinoplasty Performed?

You can undergo endonasal rhinoplasty using local anesthesia with sedation or general anesthesia. To begin, Dr. Miller will make incisions inside the nostrils to separate the skin from the cartilage. Dr. Miller can then begin the process of reshaping the cartilage or shaving off or adding bone (bone graft) through the narrow openings in each nostril. Once the shaping is complete, absorbable stitches will close any incisions. You will have a cast or nose splint after surgery to protect the nose and maintain the new shape. The procedure typically takes 1-2 hours to complete.

Recovery After Endonasal Rhinoplasty Surgery

You will need to arrange for someone to drive you home after your surgery. The cast or splint helps support the nose as it heals for the first week. You can expect to take a few days off from work so you can comfortably recover at home. It is best to keep your head elevated to help reduce any swelling. To ensure faster healing, avoid the following:

• Strenuous exercise/activity
• Blowing your nose
• Swimming
• Sleeping facedown
• Excessive chewing
• Drinking alcohol
• Smoking
• Wearing eyeglasses
• Pulling tight clothing over your head

We will remove your cast or splint after one week. You can usually return to work and normal activities within 1-3 weeks, but you should refrain from strenuous physical activity for 3-6 weeks. You will begin to see the swelling and bruising subside within 2-3 weeks, at which time you will start to appreciate the results. 

Full results usually take 6-12 weeks to be seen, while your healing will continue for the entire first year. Dr. Miller and his team will follow you through this entire process.

Scarring After Closed Rhinoplasty

The primary benefit of a closed rhinoplasty is that there’s no external evidence of the procedure. All stitches are located inside the nose, so you may feel more comfortable resuming your normal activities sooner than you might after an open rhinoplasty.

Is Endonasal Rhinoplasty Right For You? Ask the Expert

Open and closed rhinoplasty surgery are different surgical approaches, but one is not superior to the other. To determine the best procedure for you and ensure the best possible results, Dr. Miller offers a proprietary consultation process called NatraLook®. During your NatraLook consultation, he evaluates your nose and facial features while listening to your concerns and goals. This process evaluates and expands the typical plastic surgery experience into a safe, collaborative environment where you can explore your aesthetic confidence. This opportunity allows you and Dr. Miller to create a unified vision for your results and the most natural outcome possible. 

To learn more about the different types of rhinoplasty procedures Dr. Miller performs and to find out which technique is best for you, contact our New York City plastic surgery clinic today.

Dr. Philip Miller

Focusing exclusively on the face for more than two decades, double-board certified facial plastic surgeon Dr. Philip Miller blends art and science with innovation and skill to provide thousands of patients with impeccable results. He is known for pioneering the NatraLook methodology for rhinoplasty, facelifts, neck lifts, and other cosmetic procedures for the face.