Which is the best type of incision in Rhinoplasty. Inverted v or the step incision or parallel lines?

The main difference between a closed and open rhinoplasty is the incision on the columella. Most surgeons use either the "V" incision or the "Stair-step" incision for an open rhinoplasty.  They are both reasonable approaches and so long as the incision is reapproximated well, then it will heal nicely.  My personal preference is for the stair-step incision. Dr. B

Dear nearlynatural in Los Angeles, California:



I really cannot answer why a surgeon would have 2 scars but I am pleased to hear that your incisions have healed well.  I think you pose a question that should be answered by the surgeon.  For the benefit of those readers who are viewing your question, I think you shared a very important subject.  One must ask about incisions.  Where are they located? Will they be visible? What are the advantages and disadvantages of the open rhinoplasty versus closed rhinoplasty? Some of the world’s best rhinoplasty surgeons do their procedures by the open approach and some of the world’s best rhinoplasty surgeons used the closed approach.  It is all about personal preference.  What counts more than anything is the result. 





    Best wishes,





Robert Kotler, MD, FACS



Over 4,500 nasal procedures performed

The best incision for a rhinoplasty is NO external incisions. A closed rhinoplasty approach accomplishes making all the changes inside the nose such as shaving down the dorsal hump, placement of cartilaginous spreader grafts, suture techniques, and narrowing the bridge line, with all of the incisions placed on the inside of the nose. For many examples, please see the video and the link below  to our closed rhinoplasty photo gallery

There is no "best" incision. In skilled hands they all yield excellent results. Trust your surgeon to use the one they are most successful with.

Open rhinoplasty or external approach consists of making an incision on the columella (band of skin between your nostrils). There are a few patterns out there: straight line, stair step, and inverted-V. I'm in the inverted-V camp. It's a irregular (not straight) line (helps to camouflage) and symmetric. I enjoy revision rhinoplasty, so I also like the inverted-V because it's easier to revise. On a stair step, one of the limbs of the stair can come too close to the top or bottom of the columella, with no room for revision. It is important how your surgeon closes this incision. I take a long time to close this small area of skin to avoid the tell tale signs of the external approach. When closed meticulously, it's essentially invisible from the bottom and the side views. Talk to your surgeon about their approach and closure, so you know what to expect. 

Whether to do an open or closed technique for rhinoplasty is one of the ongoing disputes in plastic surgery that is hotly debated.  In many cases, a closed approach is very appropriate, and avoids ANY scar externally.  In some cases, there are advantages to the open technique, which requires a scar in the columella.  I do BOTH types of rhinoplasty, depending on the patient's skin, and the nature of the problem.  For open procedures, I prefer the step incision.

Dear nearlynatural, I would suggest for patients that they would use the incision technique that their surgeon prefers. When these incisions are placed properly and re-approximated well they heal remarkably with no visible signs of an incision. Best regards, Michael V. Elam, M.D.

We all have our preferred incision.  I have used the stair-step incision for years and have never seen one heal poorly.  Consequently I highly recommend it for my patients.Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)Beverly Hills, California