Can a surgeon avoid cutting the skin separating the nostrils to avoid scarring?

Yes. This procedure is called "closed" or endonasal rhinoplasty. It is the oldest rhinoplasty method and I use it exclusively. The open approach became popular in the mid 1980's because surgeons were frustrated at not being able to perform the new grafting methods the way they were described endonasally. The open approach is more popular in the US, though not overseas. Among the plastic surgeons who lecture and appear on panels, I am unfortunately usually the only surgeon who uses the open approach exclusively. I wish that were not the case.

I do not prefer closed rhinoplasty to avoid the scar, though that is a benefit. I prefer the closed approach because it is gentler, less destructive of normal support mechanisms, less likely to cause new deformities, and because it gives the surgeon more control over the result, especially in the tip.

You should be able to find a surgeon in your area who does closed rhinoplasty. Just make sure that you like his or her results in nasal shapes like yours, and that you trust and like the surgeon.

There are 2 types of Rhinoplasty: the open and the closed tip. It seems that most surgeons you have seen have recommended to use the open tip procedure where thy cut the columella (the skin separating the 2 nostrils). In my practice I use them both depending on the case. In other words when there is a lot of work to be done on the tip cartillages, the open tip gives a more accurate approach and hence a potentially better result. When work needs to be done only on the dorsum, a closed tip will do the job and avoid any external incisions. Despite that, the columellar incision should not show when done in a good way. Please consult with an ASAPS member to choose the best approach for your case.

Best,

Shady Hayek, M.D.

Beirut, Lebanon