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The nasal tip is the most technically demanding part of any rhinoplasty. It is the feature people notice first, and small changes there shape the whole result. In closed (scarless) rhinoplasty, where all the work is done through the nostrils with no external scar, refining the tip is harder still: the skin and soft tissue over the tip have to settle and redrape predictably once the underlying framework has been reshaped.
At Berkeley Square Medical, Mr Taimur Shoaib uses a published, evidence-based suturing technique to make that redraping more predictable. The method is described in the peer-reviewed European Journal of Plastic Surgery (2026).
Most of the nose is bone and cartilage, which a surgeon can reshape directly. The tip is different. Its appearance depends not only on the cartilage underneath but on how the overlying skin and soft tissue drape over that new shape. After the cartilage is refined, a small pocket of “dead space” can remain between the skin and the framework. If that space fills with swelling or settles unevenly, the tip can look bulky or slightly asymmetric while it heals.
This matters more in closed rhinoplasty because the surgeon works without lifting the skin off the tip, so there is less opportunity to manage the soft tissue directly.
The technique adds a series of fine, dissolvable sutures placed in sequence through the lining inside the nostril, the soft-tissue layer (the SMAS), and the under-surface of the skin. These buried stitches gently draw the soft tissues together and close the dead space after the cartilage has been refined.
The result is that the skin redrapes more closely and evenly over the new tip shape, helping to define the tip and the natural groove above the nostril rim. Importantly, it does this without extra grafting and without converting to an open approach, so the procedure stays scarless.
The study reviewed 221 patients who had primary closed rhinoplasty, with follow-up at one week and at 3, 6 and 12 months. The outcomes were strong:
This is early, single-surgeon evidence (a Level IV study), and every nose is different, but it shows the technique is safe and reproducible in carefully selected patients.
If you are weighing up your options, our guide to open vs closed rhinoplasty explains the trade-offs, and our main rhinoplasty page covers the procedure end to end.
No. It suits many primary (first-time) cases very well, but more complex noses, and most revision rhinoplasty, may need an open approach. The right choice is made at your consultation after examining your nose.
It is an adjunctive soft-tissue technique, so it does not replace grafting where grafting is genuinely needed. In the published series, the large majority of patients did not need a secondary graft.
No. The sutures used are dissolvable and sit beneath the surface, so there is nothing to remove.
No. Closed rhinoplasty is performed entirely through the nostrils, so there is no visible scar.
To discuss whether a closed approach is right for your nose, book a consultation with Mr Taimur Shoaib.
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