Background <p>Rhinoplasty is a highly individualized procedure, and the choice of approach—closed (endonasal) or open (external)—has significant implications for nasal structure, function, healing, and aesthetic outcomes. This article presents an academic comparison between the two techniques based on anatomical, physiological, and surgical principles.</p> Results <p>The closed technique preserves the columella and maintains the three-dimensional integrity of the lower third of the nose. It utilizes internal incisions to access and modify nasal structures while preserving their natural support and function. The open approach, on the other hand, requires external incisions, detachment of key anatomical supports, and often depends on structural grafts for reconstruction. It is associated with longer healing, graft-related complications, and visible scarring.</p> Conclusions <p>Closed and open rhinoplasty are not merely alternative access routes but are two fundamentally different procedures with different goals. Closed rhinoplasty emphasizes preservation of native anatomy and function, while the open approach is better suited for revision or reconstructive cases requiring extensive modification.</p>