Choosing to undergo rhinoplasty is a deeply personal decision. Whether a patient is seeking subtle refinement, enhanced facial balance, correction of breathing problems, or complex nasal reshaping, the technique used matters — but not in the overly simplistic way many people assume. In the Tampa Bay, St. Petersburg, Clearwater, and Tampa communities, patients frequently ask whether they should insist on closed rhinoplasty (scarless rhinoplasty) or whether open rhinoplasty is truly necessary.
There is a lot of online debate about which approach is “best.” The truth is far more nuanced.
As a highly trained and experienced Tampa Bay and St. Petersburg rhinoplasty surgeon, Dr. Kailash Narasimhan emphasizes that the best rhinoplasty technique is the one that safely achieves the patient’s goals, provides the most predictable results, preserves function, and respects the nasal anatomy. Being dogmatic about only performing open or only performing closed rhinoplasty is not in the patient’s best interest — period.
Below, we explain the differences between closed and open rhinoplasty, the pros and cons of each, and why individualized treatment planning is essential.
Closed rhinoplasty, often called endonasal rhinoplasty or scarless rhinoplasty, is performed entirely through incisions made inside the nostrils. There is no external incision across the columella, meaning there is no visible scar.
Closed rhinoplasty can be an excellent option for carefully selected patients. Key advantages include:
For patients in Tampa, St. Petersburg, Clearwater, and the greater Tampa Bay area who are seeking mild to moderate cosmetic improvements or limited structural modification, closed rhinoplasty may be a fantastic approach — when performed by a surgeon skilled in this technique.
It is important to understand that while some surgeons market closed rhinoplasty as “always superior” because it avoids a scar, that mindset can actually limit surgical flexibility and compromise the final result. There are situations where closed rhinoplasty simply does not provide enough visibility, access, precision, or stability to safely and predictably reshape the nose.
Closed rhinoplasty may not be ideal for:
Choosing closed rhinoplasty solely to avoid a tiny external incision can sometimes sacrifice precision and long-term results. Inexperienced or dogmatic surgeons may attempt closed rhinoplasty in cases where visualization is limited, increasing the risk of uneven changes, breathing problems, or the need for revision surgery.
This is exactly why being overly rigid or dogmatic about “always using closed rhinoplasty” is not good medicine, not good surgery, and not good for the patient — period.
Open rhinoplasty involves a small incision placed across the columella (the tissue between the nostrils), which is connected to internal incisions. This approach allows the nasal skin to be gently lifted, giving the surgeon direct visibility of the nasal structure, including cartilage, bone, septum, and tip framework.
Open rhinoplasty provides several important advantages, especially for complex situations:
For patients in Tampa, St. Petersburg, and Tampa Bay, open rhinoplasty allows Dr. Narasimhan to perform highly detailed and structurally supportive reshaping, especially when the nose requires substantial modification.
One of the biggest concerns patients express about open rhinoplasty is the external scar. In skilled hands, this incision typically heals as a barely visible, faint line that is extremely difficult to detect once healed. With meticulous technique, precise suturing, and proper aftercare, most patients are thrilled with their results and are not bothered by the incision whatsoever.
Avoiding open rhinoplasty purely out of fear of scarring is often unnecessary — especially considering the dramatically improved control, accuracy, and long-term stability that open rhinoplasty can provide.
Both surgical approaches share common surgical risks, including:
If closed rhinoplasty is performed in cases where it is not the best choice, potential issues may include:
Open rhinoplasty may involve:
However, these trade-offs are often worth it in order to achieve a more precise, stable, and predictable result.
Some surgeons believe “open rhinoplasty is the only correct way.” Others advertise themselves as “closed rhinoplasty surgeons only.” Both extremes are problematic.
Rhinoplasty is one of the most complex and nuanced operations in all of plastic surgery. No two noses are the same, and no two patients in Tampa Bay or St. Petersburg have identical anatomy, skin thickness, breathing structure, or aesthetic goals.
Being overly attached to one technique limits surgical judgment and ignores the individuality of the patient.
A highly trained rhinoplasty surgeon must:
This is patient-centered rhinoplasty. This is modern rhinoplasty. This is the right way to care for patients — period.
Dr. Kailash Narasimhan is a highly trained Tampa Bay plastic surgeon specializing in rhinoplasty, serving patients in St. Petersburg, Tampa, Clearwater, and the surrounding region. Rather than forcing every patient into one surgical approach, he evaluates:
From there, he recommends the most appropriate approach — whether that means closed rhinoplasty, open rhinoplasty, or a hybrid technique — to achieve the safest and most natural-looking outcome.
There is no “one answer” that applies to every patient. During a comprehensive rhinoplasty consultation at Dr. Narasimhan’s St. Petersburg or Tampa Bay office, patients receive a personalized evaluation and honest discussion of which approach makes the most sense for them.
Some patients are ideal candidates for closed (scarless) rhinoplasty. Others will benefit far more from open rhinoplasty due to anatomy, complexity, or aesthetic goals. What matters most is choosing a surgeon who understands both approaches and prioritizes individualized care, safety, and predictable results.
If you are considering rhinoplasty — whether cosmetic, functional, or revision — trust your care to a plastic surgeon who understands anatomy, balance, breathing, and advanced surgical techniques rather than one who relies on a single “one-size-fits-all” approach.
To learn whether closed rhinoplasty or open rhinoplasty is right for you, schedule a consultation with Dr. Kailash Narasimhan, leading plastic surgeon serving St. Petersburg, Tampa, Clearwater, and the greater Tampa Bay area.
