One of the things patients ask me most often before a nose operation is whether it will leave a scar, and whether people will be able to tell. I understand the worry completely. We are talking about the middle of your face. The answer changes with the technique we use. In closed rhinoplasty every incision stays inside the nose, so there is nothing on the outside. In the open technique there is a small scar in the middle of the nose. Let me describe both exactly as they are.
Does the closed technique leave a scar in rhinoplasty?
In the closed technique the entire operation is done from inside the nose. There is no external incision at all on the columella, the small column of tissue that separates your two nostrils. So once healing is finished, there is no scar for anyone looking at you to see. Because we never make that incision, some of us call the closed approach scarless rhinoplasty. The surface where a scar could form is inside the nose, out of sight.
Where is the scar in open rhinoplasty, and how visible is it?
In the open technique we add a short horizontal incision across the columella to improve our view. It is called a transcolumellar incision. It is about 4 to 5 millimeters long and it sits in the shadowed area just under the tip of the nose. So yes, technically a fine scar forms there, and I am not going to pretend otherwise. But the columella heals extremely well. When the incision is closed neatly, that scar usually doesn’t end up being very visible. In most patients it fades to the point of nearly disappearing, close to looking like no surgery was done. Saying the scar will definitely be invisible would be wrong. Saying that in most patients it becomes unnoticeable is accurate.
Where exactly are the incisions made in closed rhinoplasty?
We place them on the inner surface of the nostrils and reach the cartilage and bone from there. The bridge, the cartilage and, where necessary, the bone are all shaped through those internal incisions. With nothing on the outside, you go through healing without a stitch line to worry about. In my hands the operation takes 2 to 3 hours on average. I don’t usually go under that, because I take separate care over every part of the nose. Which incision plan suits you comes down to your anatomy and to the change we are aiming for.
Do rhinoplasty scars fade over time?
The columella scar from open surgery heals in stages. It fades substantially over the first 3 to 6 months, and after that, in most patients, it turns into a faint line close to looking as though no operation was done. Protecting the area from the sun and following the aftercare we describe both help it heal better.
Your nose reaching its final shape is a separate matter, and there the deciding factor is your skin. In patients with thin skin we can say the result is there at 6 months. With thick skin it takes 12 to 18 months. On average a nose settles into its final shape within a year. In the closed technique there is no external scar, so there is no scar healing to wait out.
Is the closed or the open technique better for scarring?
If you look only at the external scar, the closed technique has the advantage, because it doesn’t leave one. But we don’t choose a technique on that basis alone. For very complex tip work and for some revision operations, the open technique can be preferable because it gives a wider view.
What really decides whether a result looks natural isn’t the technique. It is the aesthetic judgment of the surgeon. Some surgeons produce noses that look obviously operated on. I would rather your nose looked like a nose. That is why I work on your photographs before surgery and spend time understanding both your expectations and your anatomy. In every patient it suits, I use the tissue-sparing approach, preservation rhinoplasty, where we protect the bridge and the ligaments of the nose as far as possible. Healing is quicker that way and the result looks more natural. So the useful question isn’t which technique is better in the abstract. It is which one is right for your nose, and we work that out together at your consultation.
Frequently Asked Questions
Is there really no scar at all after closed rhinoplasty?
There is no scar anyone can see, because every incision is made inside the nostrils. Healing happens on an internal surface that stays out of view.
How long does the scar from open rhinoplasty take to disappear?
It fades substantially in the first 3 to 6 months. In most patients it becomes a faint line within 6 to 12 months, and it isn’t noticeable unless someone looks closely.
Is the closed technique suitable for every nose?
It is suitable for most first-time rhinoplasty. For very complex tip work, or for some revision cases, the open technique may be necessary. We assess this at your consultation.
What can I do to help the scar heal well?
Stay out of the sun and follow the scar care we describe. We set your personal care plan together as you heal.
Alongside the question of scarring, our articles on open or closed rhinoplasty and swelling and bruising after surgery are worth reading too.
Dr. Alper Eskalen talks through the question of scarring in rhinoplasty with all of these details in mind.
