1101 MADISON ST #1280 SEATTLE, WASHINGTON 98104 | (206) 624-6200
The Facial Plastic Surgery Center
Dr William Portuese - Board Certified Facial Plastic Surgeon

Closed Rhinoplasty to widen a narrow nose

Some patients are born with an unnaturally narrow nose and would like to have it cosmetically widened. Other patients are born with an “hourglass deformity” which means they have pinched or very narrowed upper lateral cartilages in the mid-portion of the nose. Typically these patients have wide nasal bones, a dorsal hump, and a wide tip. The inverted upper lateral cartilages appear concave and relatively speaking, can make the tip look more bulbous and the bridge look wider. To widen a narrow nose requires osteotomies placed in the nasal bones, which include both medial and lateral osteotomies. The medial osteotomies are placed at the junction between the upper lateral cartilage and the lower portion of the nasal bones. Instead of narrowing the nasal bones, they’re actually cantilevered out more widely, also known as reverse osteotomies. Cartilaginous spreader grafts are then inserted in the space where the medial osteotomies were placed to hold the nasal bones open in their new wider position. The cartilaginous spreader grafts can be harvested from the dorsal hump that’s been removed or from inside the nose from nasal septal cartilage.

Closed Nose Surgery

The spreader grafts are also placed in a sub-perichondrial and sub- periosteal pocket. It’s also important to make sure the tip of the nose balances with the new bridge line. In some patients the tip may need to be narrowed, and other patients, the tip needs to be widened. A conservative cartilage removal is required to narrow the tip, while cartilage-grafting techniques are required to widen it. Rhinoplasty is a very difficult endeavor, so is very important to choose a rhinoplasty specialist based on extensive experience performing osteotomies, spreader grafts, and advanced bone and cartilage work to create a natural appearance. Dr. Portuese performs all of his nasal surgery procedures at the Seattle Rhinoplasty Center, which is a state-of-the-art Medicare certified outpatient surgery center located in Seattle Washington


Closed rhinoplasty, also known as endonasal rhinoplasty, is a surgical technique used to reshape and enhance the nose without external incisions or visible scars. While both closed and open rhinoplasty have their advantages, closed rhinoplasty offers specific benefits. Here are some key advantages of closed rhinoplasty:

No Visible External Scarring: One of the primary benefits of closed rhinoplasty is that all incisions are made inside the nostrils. This means that there are no visible external scars after the surgery. The absence of external scarring can be particularly appealing for patients who are concerned about the potential visibility of scars or those seeking a discreet procedure.

Reduced Swelling and Faster Recovery: Closed rhinoplasty typically involves less extensive dissection of the nasal tissues compared to open rhinoplasty. This can result in reduced swelling and a faster recovery time. With less disruption to the nasal tissues, patients may experience less bruising, minimal nasal trauma, and a quicker return to normal activities.

Preservation of Nasal Support Structures: Closed rhinoplasty allows for direct access to the nasal structures through internal incisions. This technique enables the surgeon to make precise modifications to the cartilage and bone while maintaining the integrity of the nasal support structures. Preserving these structures helps maintain the strength and stability of the nose, which is particularly important for patients with relatively good nasal anatomy or those requiring minor adjustments.

Shorter Surgical Time: Closed rhinoplasty typically requires less operating time compared to open rhinoplasty. The procedure involves fewer steps, as there is no need for an external columellar incision or the lifting of the nasal skin. Shorter surgical time can reduce the overall anesthesia duration and decrease the risk of potential complications.

Suitable for Selected Cases: Closed rhinoplasty is often suitable for patients seeking minor to moderate nasal refinements, such as tip refinement, nostril narrowing, or small dorsal hump reduction. It can also be an option for patients who have previously undergone rhinoplasty and require minor revisions. The closed technique allows for targeted modifications and can yield excellent results for appropriate candidates.

Washington Ambulatory Surgery Center Association Washington State Medical Association American Academy of Facial Plastic and Reconstructive Surgery Real Self