Closed rhinoplasty uses incisions inside the nostrils, so there is no visible external scar. Open rhinoplasty adds a small incision across the columella, the strip of skin between the nostrils, which usually heals to a fine line that is difficult to see at conversational distance. If the nostrils are narrowed, small scars sit in the natural crease where each nostril meets the cheek. Scars typically mature over 12 to 18 months.
Closed rhinoplasty incisions
In a closed (endonasal) approach, all the incisions are made inside the nose, along the lining of the nostrils and septum. They heal without any visible external mark. The inside of the nose may feel crusty for a few weeks as these incisions heal, and gentle saline rinses help keep them clean. A closed approach suits many changes to the bridge and some tip refinements, though it gives less direct access to the tip cartilages.
Open rhinoplasty incisions
An open approach combines the internal incisions with a short cut across the narrowest part of the columella. It is usually shaped as a small inverted ‘V’ or stepped line, which helps it blend and heal neatly. This allows the skin of the lower nose to be lifted so the tip cartilages can be seen and reshaped precisely, which is useful for complex tip work, revision surgery and grafting. Fine stitches are removed at around a week. The scar is often pink at first, then gradually fades and flattens.
Nostril (alar base) reduction scars
Where the nostrils are wide or flared, a small wedge of skin can be removed at the base of each nostril. The incisions are placed in the alar-facial groove, the natural crease where the nostril joins the cheek, and sometimes extend slightly inside the nostril sill. Placed carefully, these scars usually become very faint. Occasionally they can be slightly visible, particularly if they heal thickened or with a colour difference, which is why the decision to reduce the nostril base is made carefully.
How scars mature over time
- First two weeks: incisions are closed with stitches and look red; external stitches are usually removed after about a week.
- Weeks two to six: scars may be pink and slightly raised as healing tissue forms.
- Three to six months: the colour begins to soften and the scar starts to flatten.
- Twelve to eighteen months: most scars reach maturity, becoming pale, flat and fine.
Scars can take longer to settle in people with darker skin tones, who can also be more prone to pigmentation changes or thickened scars.
Caring for your scars
Keep external incisions clean and dry as instructed until the stitches are removed. Once the skin has healed fully, usually after two to three weeks, silicone gel can be applied to the columella or nostril base scars, which may help them flatten and fade. Gentle massage may also be recommended. Protect scars from the sun with a high-factor sunscreen for at least a year, because sun exposure can darken healing scars. Avoid picking crusts inside the nose, and do not smoke, as nicotine impairs healing.
When a scar is not healing well
Contact the surgical team the same day if a wound becomes increasingly red, hot, swollen or starts to discharge, or if you develop a fever, as these may indicate infection. A scar that becomes raised, itchy or thickened over the months after surgery may be hypertrophic or, rarely, a keloid. These can often be improved with silicone, steroid injections or, in some cases, scar revision. A notched columella scar can occasionally be refined with a minor procedure once it has matured.
Scars and choosing an approach
The choice between open and closed rhinoplasty is based on the changes required, not on scarring alone, because the columella scar usually heals well. Mr Nassab will explain which approach suits your nose and where any incisions will be placed. Rhinoplasty costs from £8,950 and the £150 consultation fee is separate. Cosmetic surgery is only for adults aged 18 and over.
Frequently Asked Questions
Will people see my rhinoplasty scar?
With closed rhinoplasty there is no external scar. After open rhinoplasty, the columella scar usually fades to a fine line that is hard to notice.
Is open or closed rhinoplasty better for scarring?
Closed leaves no external scar, but open gives better access for complex work. The choice depends on what your nose needs.
How long do rhinoplasty scars take to fade?
Most scars mature over 12 to 18 months, becoming paler and flatter with time.
Do nostril reduction scars show?
They are placed in the natural crease beside the nostril and usually become faint, although occasionally they remain slightly visible.
