# Closed Structural Rhinoplasty

## TL;DR

This paper presents a closed rhinoplasty technique that allows for tip suturing without a visible scar.

## Contribution

The paper introduces endonasal techniques to replicate open rhinoplasty sutures through a closed approach.

## Key findings

- A survey found that 11% of ASPS surgeons reported noticeable scars in over 25% of patients.
- Closed rhinoplasty can achieve tip restructuring with permanent sutures without a problematic scar.

## Abstract

Closed rhinoplasty had initially been relegated to a reductive procedure that did not provide access to place structural sutures for tip support. Despite the influence of closed rhinoplasty advocates Sheen, Constantian, Guerrerosantos, Bravo, Kamburoglu, Tezel, Ersoy, Cakir, Valdivia and others who have produced excellent results, most surgeons prefer the open approach. The scar resulting from open rhinoplasty is considered a relatively innocuous necessity to achieve sophisticated results.

Endonasal methods to replicate the tip suturing techniques of open rhinoplasty were developed over 39 years by the senior author. This paper describes, and supplemental videos demonstrate, the tip suture passing and grafting techniques through the closed approach. To evaluate the frequency of columella scar negative consequences, a survey of ASPS members was done.

Videos and photographic examples demonstrate the success of these original closed rhinoplasty suture techniques. In a survey of ASPS surgeons, 11% of respondents report that over 25% of patient’s scars were noticeable at intimate distances.

Tip restructuring with permanent sutures can be readily done via the delivery technique of closed rhinoplasty without creating a columella scar that may be problematic.

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The online version contains supplementary material available at 10.1007/s00266-025-05122-1.