Open Rhinoplasty in Korea: When It's Needed, Scar

The short answer: open rhinoplasty is nose surgery that adds one small incision across the columella, the strip of skin between your nostrils. That cut lets the surgeon lift the skin of the tip and see the cartilage directly. It is usually chosen when the tip needs real support or rebuilding, and the small columella scar is the trade for that view.

Hello, I'm Dr. Choi Hang-seok, Head Surgeon at TIANA Plastic Surgery in Gangnam, Seoul.

TIANA performs only rhinoplasty and revision rhinoplasty. I handle each patient one-to-one, from consultation through surgery, anesthesia and aftercare. Before surgery, 3D-CT imaging shows the bones, septum and airway, which helps decide whether your nose needs an open or a closed approach.

What is open rhinoplasty?

Open rhinoplasty is a way of reaching the inside of the nose, not a separate kind of result. The surgeon makes incisions inside the nostrils and joins them with a short cut across the columella. The skin over the tip can then be folded up, a little like lifting a hood.

With the skin lifted, the tip cartilages, the septum and the lower bridge are in plain view. That matters because many tip changes depend on stitching cartilage grafts in exact positions, millimeter by millimeter.

In closed rhinoplasty, every incision stays inside the nostrils. The surgeon works through a narrower tunnel, partly by direct view and partly by feel. If you want the closed side of the story, six common myths about closed rhinoplasty in Korea covers it.

Why does the open approach give a better view?

The tip is the most detailed part of the nose. Its shape comes from two small curved cartilages, the strength of the septum behind them and the thickness of the skin on top.

When the surgeon can see all of that at once, three things become easier:

• Checking symmetry: both sides of the tip can be compared directly before anything is fixed
• Placing grafts precisely: a strut, a tip graft or an extension can be stitched exactly where it is needed
• Building support that lasts: grafts fixed under direct view are less likely to shift as the nose heals

Doctor's note

I don't choose open because it is "more thorough" in general. I choose it when the plan for your tip depends on stitching cartilage in a precise position. If your nose doesn't need that, I'd rather not add the columella incision.

When is open rhinoplasty needed, and when is closed enough?

In open vs closed rhinoplasty, the incision follows the plan, not the other way round. A useful way to think about it: is your tip a shape problem or a support problem? Light reshaping can often be done closed. Adding strength, length or rebuilt structure usually points to open.

What your nose needs	Typical work	Usual approach
Low bridge only	Bridge implant or cartilage on the bridge	Often closed
Small hump or wide bony bridge	Hump reduction, osteotomy	Often closed
Tip that needs light refinement	Small cartilage changes	Can be closed
Short or upturned nose	Septal extension graft to bring the tip down	Usually open
Round tip under thick skin	Cartilage support built into the tip	Usually open
Tip support rebuilt with rib cartilage	Rib cartilage grafts (own or donated)	Usually open
Revision after earlier surgery or contracture	Scar release, new cartilage, sometimes implant removal	Usually open
Crooked tip or septum pulling the nose sideways	Septum straightening and support	Often open

This is a general pattern, not a rule. Two noses with the same label can need different approaches, which is why the decision is made after examination.

Septal extension and tip support

A septal extension graft is fixed to the end of the septum to project, lengthen or angle the tip. It has to be straight and firmly stitched, so it is almost always placed through an open approach.

Rib cartilage

When septal or ear cartilage isn't enough, rib cartilage (the patient's own or donated) can be carved into grafts. Large or multiple grafts need room and a clear view. More on healing is in rib cartilage rhinoplasty recovery.

Revision and crooked noses

A nose that has been operated on before often has scar tissue, thin cartilage or contracture. The surgeon needs to see what is left before rebuilding it. A crooked nose is similar when the tilt starts in the septum or the tip; crooked nose surgery and its limits explains which layer is usually responsible.

Example case (revision rhinoplasty): side view before surgery (left) and 2 weeks after (right). Procedures: revision rhinoplasty, silicone bridge implant, tip with septal and donor rib cartilage, bulbous tip refinement, short-nose correction, osteotomy. Results vary between individuals; swelling, bruising, asymmetry and infection are possible risks. Shared with the patient's consent.

Example case (bulbous tip, short nose): side profile before surgery (left) and 3 months after (right). Procedures: silicone bridge implant, tip with septal and donor rib cartilage, bulbous tip refinement, short-nose correction, osteotomy, columella and nasolabial angle adjustment. Results vary between individuals; swelling, bruising, asymmetry and infection are possible risks. Shared with the patient's consent.

What does the open rhinoplasty scar look like?

The scar is a short line across the narrowest part of the columella. Surgeons often shape it as a small zigzag or step, so it doesn't heal as one straight line that catches the eye.

In most people it settles into a fine line that is hard to notice at a normal distance, especially from the front. It can look pink or slightly raised at first and usually fades over the following months. How it heals depends on your skin type, how carefully the edges are closed and how you look after it.

A few honest points:

• No surgeon can promise the scar disappears. It becomes less visible; it does not vanish.
• Some people scar more. If you have a history of thick or raised scars, tell the surgeon at consultation.
• Aftercare helps. Keep the stitches clean, follow the instructions you're given and protect the area from strong sun while it is still pink.

In consultation, patients often tell me the scar is the thing they fear most. My answer is that the scar is small, but it is real, so it should only be there if the open approach changes your result enough to be worth it.

Open rhinoplasty recovery: stitches, swelling and your stay

Stitches and splint

The stitch schedule is the same as for other rhinoplasty at TIANA. The splint and outer stitches, including the columella stitches, usually come off around day 7. The stitches inside the nose come out around day 14. Timing varies between people and is confirmed at surgery.

Plan on 7 to 14 nights in Seoul, and at least 7. If you fly home around day 7, you leave with a referral letter and a surgery certificate so a local doctor can remove the inner stitches. How long rhinoplasty takes to heal walks through time off work.

Swelling compared with closed

Open rhinoplasty swelling follows the same broad pattern: major swelling tends to settle over 1 to 2 weeks, and the nose usually starts to look natural at around 3 to 4 weeks. After open rhinoplasty, the tip often stays a little fuller for longer than the bridge, because the tip skin was lifted and the tip usually received the most work.

Much of that difference comes from scope rather than the incision itself. A closed bridge-only case and an open case with rib cartilage and septal extension are very different operations, so compare your own plan, not the label.

What are the risks of open rhinoplasty?

Open rhinoplasty carries the general risks of nose surgery, plus a few linked to the columella incision. The American Society of Plastic Surgeons lists the general rhinoplasty risks.

• Swelling, bruising and bleeding
• Infection
• Numbness of the tip, which usually improves over time
• A visible or thickened columella scar
• Slow healing at the edges of the columella incision
• Asymmetry, or grafts that shift or warp as the nose heals
• A blocked feeling while swelling lasts
• The need for revision in some cases

Tell the surgeon about smoking, past nose surgery or injury, and any blood-thinning medicine or supplements. Don't stop prescribed medicine on your own; ask your prescribing doctor.

How TIANA decides between open and closed

For open rhinoplasty in Korea, as anywhere, the approach is the last decision, not the first. I start with what your nose needs: the bridge height, the tip shape and support, the septum, the skin thickness and any earlier surgery.

1. Photo or video consultation first. Send five photos on WhatsApp: front, both 45-degree angles and both side profiles. You can also book a free video consultation on Google Meet with an interpreter (Dr. Choi first, then our consultation manager for the quote).
2. Examination and 3D-CT in Seoul. At the in-person visit, I examine the nose and 3D-CT shows the bones, septum and airway.
3. One plan, explained. I tell you which parts can be done closed, which need open and why. The final plan and quote are given at that visit.

Question to ask any surgeon	Why it matters
Which part of my nose needs open access?	It shows whether the plan is driven by your tip or by habit
Is my tip a shape problem or a support problem?	Support work usually points to open
Which cartilage will you use?	Septal, ear or rib cartilage changes the scope
How will the columella scar be closed and cared for?	Tells you how the incision is planned
How long should I stay in Seoul?	Stitch removal around day 7 and day 14 sets your trip

More articles on approaches and planning are in all Korean rhinoplasty articles, and how the bridge and tip fit into one design is on TIANA's English rhinoplasty page.

Summary

• Open rhinoplasty adds a small columella incision so the tip cartilage can be seen and grafts stitched precisely.
• It is usually chosen for septal extension, rib cartilage, revision, a crooked tip or a tip that needs strong support. A low bridge or small hump can often be done closed.
• The columella scar usually fades to a fine line, but it does not disappear completely.
• Outer stitches come out around day 7 and inner stitches around day 14; plan 7 to 14 nights in Seoul.
• Tip swelling often lasts longer after open surgery, mostly because more tip work was done.

Send five photos on WhatsApp (front, both 45-degree angles and both side profiles) and tell us whether a surgeon has already suggested open rhinoplasty. You'll get a reply in English with the likely scope and how the quote is worked out, and you can book a free Google Meet video consultation from there.