Since the very birth of nasal surgery, in order to address a whole variety of functional and aesthetic problems, the closed approach has been adopted for the nasal septum and pyramid by means of incisions inside the nasal cavities.
The lesser degree of invasiveness, together with the possibility for surgeons to feel the osteocartilaginous nasal structures with their own fingers and decide upon their anatomical correction, have made rhinoplasty with the closed approach one of the most fascinating and difficult operations in aesthetic surgery.
The results obtained with this approach still prove satisfactory today, as in the past, as long as certain prerequisites are complied with. On the one hand, closed rhinoplasty makes it possible to obtain excellent results with quick and precise execution in cases where a hump on the nasal dorsum is combined with nasal septum deviation and turbinate hypertrophy. On the other, it entails the risk of postoperative asymmetry when used to address major defects of the nasal tip, requiring sophisticated procedures of reshaping. I am also convinced that it presents further limitations in secondary rhinoplasties, whereas the greater exposure of the anatomical regions offered by the open approach can lay the foundations for complete success.