Rhinoplasty is usually described as one operation. At this practice it is described as several, and the difference between them is how much of your own tissue goes into the nose.
That is the most useful thing to understand before a consultation, because it explains why two people can be quoted very different operations for what sounds like the same request.
Open or closed, first
Every rhinoplasty is done one of two ways, and the choice governs how much the surgeon can see and reshape.
In a closed operation the incisions sit inside the nostrils. Nothing is visible afterwards, and the surgeon works through a more restricted view.
In an open operation a small additional incision crosses the columella, the strip of skin between the nostrils, so the skin can be lifted and the framework seen directly. It leaves a fine scar there that usually fades well.
Open is not a bigger version of closed for its own sake. It is chosen when the work needs direct vision, which is generally when cartilage is being grafted and shaped rather than simply augmented.
The four augmentations the practice describes
The practice’s Thai-language page for nose augmentation sets out four versions, chosen according to the structure of each individual nose as the surgeon assesses it.
| Version | What is used | Approach | Where it is performed |
|---|---|---|---|
| Standard augmentation | A silicone implant, carved for the individual case | Closed | At the clinic |
| Open, with ear cartilage | Silicone plus cartilage from the ear | Open | At the clinic |
| Open, with septal and ear cartilage | Silicone plus septal cartilage plus ear cartilage | Open | At the clinic |
| Open, with rib cartilage | Silicone plus ear cartilage plus rib cartilage | Open | At a hospital |
Read the last column. As more of your own cartilage is used the operation becomes larger, and the fourth version moves out of the clinic and into a hospital.
Why the ladder exists
The pattern is not arbitrary. Each step adds material that behaves more like the nose it is joining.
An implant reliably adds height to a bridge and does it through a short operation. It is also a foreign material, and the recognised problems with nasal implants — movement, thinning of the skin over them, and in a minority of cases infection or the implant working its way out — are the reason surgeons think carefully about where they are used.
Your own cartilage carries none of that foreign-body risk and integrates with the tissue around it. It is better suited to the tip, where support and shape matter more than height, and where an implant sits least comfortably.
Rib cartilage enters the picture when a nose needs substantial structural rebuilding and there is not enough septum or ear to supply it. It also means a second surgical site, which is part of why that version is done in hospital.
The implant is carved for you
One detail on the practice’s page is worth pulling out, because patients often assume the opposite.
The silicone is described as shaped case by case rather than fitted off the shelf, with the stated aim of a nose that suits the face rather than looking like a block or a hard ridge.
That is the difference between an implant that reads as a nose and one that reads as an implant, and it is a fair thing to ask about directly.
Silicone used in surgery is a regulated medical device. Switzerland’s Swissmedic explains how medical devices are authorised and monitored, which is the kind of oversight worth knowing exists whatever is implanted.
Reduction is a different operation
Everything above is about building a nose up. Taking one down is not simply the reverse.
Reducing a dorsal bump means working on bone as well as cartilage, and the framework often has to be narrowed and stabilised afterwards so the profile stays straight as it heals.
The practice’s published figures reflect the difference: about one hour of surgery for augmentation, and one to two hours plus a day of hospitalisation for reduction.
Which of the two your nose needs is decided by examination, not preference, as the practice’s list of procedures and your consultation will establish.
The sequence, step by step
The order below is typical. Yours is confirmed by your surgeon and varies considerably with which version is planned.
- Assessment and consent, with the plan confirmed and photographs taken.
- Anaesthetic, which varies with the size of the operation; confirm which applies to you.
- Access, through the nostrils or with the additional columellar incision.
- Harvesting graft material, from septum, ear or rib, if the plan uses it.
- Shaping the framework, adding structure or reducing it, and building tip support.
- Closure, with fine sutures.
- Support, usually a splint on the outside and sometimes packing or splints inside.
Step four is the one to ask about. If cartilage is being taken, find out from where, what that site will feel like afterwards, and whether it changes where the operation happens.
Step seven is worth asking about too. Whether anything is packed inside the nose, and for how long, makes a considerable difference to how the first days feel.
What you will not see for a while
Worth knowing before the day, because the first look is misleading and everybody takes it seriously anyway.
The splint comes off after about a week, at which point the nose is swollen, and what you see then is not the result.
Most swelling resolves over about three months, and the tip, where the skin is thickest, carries on refining for a year or more.
That timeline is set out properly in rhinoplasty recovery stage by stage, and it is the single biggest difference between this operation and the rest of the face.
Questions people ask
Is open rhinoplasty worse than closed?
It is a different access rather than a worse one. It adds a small scar on the columella and better direct vision, which is why it is used when cartilage is being shaped rather than simply added.
Does taking cartilage from my ear change its shape?
It is taken from a part of the ear chosen so the outline is preserved, and it leaves a scar in or behind the ear. Ask to see where, and what the site will feel like while it heals.
Why would my operation be in a hospital?
The practice describes the rib cartilage version as performed in hospital rather than at the clinic. If that is being proposed for you, ask why your nose needs it and what the alternative would leave undone.
How do I find out which version suits me?
By being examined, since it depends on your existing structure and skin. The clinic contact details cover both locations, and much can be discussed first, as remote consultations before travelling for surgery explains.
Medical information notice. This page is general information. It is not medical advice and does not replace consultation with a qualified medical professional. All surgery carries risk; suitability, recovery and results vary from person to person and are determined by individual medical assessment.