Rhinoplasty is performed through either an open or closed approach. In the open approach, a small incision is made across the columella, and the skin is lifted off the nose, exposing the underlying bone and cartilage framework. This approach provides good visualization of the framework for more complex problems. In the closed approach, small incisions are made inside the nostrils and more limited access is gained to the framework. For either approach, the skin is separated from the supporting framework. Sculpting of the framework is then performed by reducing the support or augmenting the support with grafts. The nasal bones may be altered by fracturing them. The nasal skin is then redraped over the nose.