Rhinoplasty can be carried out under general anaesthetic, sedation, or local anesthetic. Initially, local anesthesia,which is injected to numb the area temporarily. There are two possible approaches to the nose: closed rhinoplasty surgery and open rhinoplasty surgery. 

In closed rhinoplasty, incisions are made inside the nostrils. In open rhinoplasty, an additional inconspicuous incision is made across the piece of skin that separates the nostrils. The rhinoplasty surgeon separates skin and soft tissue  from the underlying structures. The nose bone is reshaped, and the incisions are sutured closed. Some plastic surgeons use a stent or packing inside the nose, and tape or stent on the exterior.

In some cases, the surgeon may shape a small piece of the patient's own cartilage or bone, as a graft, to strengthen or change the shape of the nose. Usually the cartilage is harvested from the septum. If there isn't enough septum cartilage, which can occur in revision rhinoplasty, cartilage can be harvested from the concha of the ear or the ribs. In the rare case where bone is required, it is harvested from the head, the hip, or the ribs. Sometimes an implant may be used to augment the  nose.