Rhinoplasty is always performed using one of two basic techniques: an external (open) approach or an internal (closed) approach. With the external approach, a small incision is made on the columella, or the column of skin between the nostrils on the underside of the nose. With the internal approach, all incisions are confined to the inside of the nose.
One significant disadvantage of the internal approach is the decreased visibility of and access to the inside of the nose, whereas the external approach allows the infrastructure of the nose to be completely exposed and accessed. This greater exposure often allows for a more precise and meticulous surgery and is generally preferred when performing tip work, complicated revision procedures or septorhinoplasty. The small, well-concealed scar on the columella is a small sacrifice when compared to the advantages, and this scar generally heals to a small, fine-line scar that is barely visible. There are still cases where the internal approach can be appropriate, for instance when addressing a hump on the nose.
External rhinoplasty is performed with general anesthesia. Depending on the work that is being performed, the surgery can take one to three hours to complete. The recovery is not significantly different from the internal approach and lasts about one week. Patients may experience some swelling, bruising and discomfort. Stitches are removed after 3 to 7 days and patients are able to return to work and other normal activities after one week. Strenuous activities and exercise should be postponed for 2 weeks or more.