06/10/2026
Our new chapter on Endonasal Closed Scarless Rhinoplasty is out now in the newest edition of Master Techniques in Rhinoplasty. Endonasal Closed Scarless Rhinoplasty is a closed surgical technique in which every incision is made inside the nose. Because no incision is placed across the columella (the strip of skin between the nostrils), no external scar is created, and the surgeon never lifts the skin of the nose away from its underlying framework as is done in the open approach. The nose is reshaped through small, hidden incisions, working with the cartilage and bone in their natural position.
The transcartilaginous approach described in Chapter 20 is a specific endonasal technique in which the surgeon makes a precise incision through the lower lateral cartilage itself, and refines the tip of the nose while preserving the lateral portion of the lower lateral cartilage. Preserving this lateral cartilage is critical: it is what prevents alar collapse, alar pinching, and the visibly operated look that more aggressive techniques can.
In my view, more than ninety percent of primary rhinoplasty cases can be performed endonasally. That figure runs against the trend of the past two decades, in which most rhinoplasty teaching has shifted toward an open approach. The reason for that shift, the chapter explains, is not that the open approach produces better results in most cases, but that the endonasal approach has a longer, more difficult learning curve, and fewer surgeons commit to mastering it.
Advantages of Closed, Scarless Rhinoplasty:
1. No external incisions. No visible scars
2. Preservation of natural nasal support structures
3. Less tissue disruption and trauma
4. Faster, more comfortable recovery
5. Reduced swelling and bruising
6. Lower risk of over-reduction or structural collapse
7. Results designed around the individual face, not a template
8. Maintains long-term stability of the nose
9. Allows refinement without obvious surgical signatures
10. Focus on proportion, restraint, and natural balance