Scar Care After Rhinoplasty: Columella, Alar Base, and the Rib Harvest Site

Where rhinoplasty incisions are placed, how each site behaves over the first months, and what care is advised for the columella, the alar base, and the rib cartilage harvest site.

Rhinoplasty leaves scars, and the honest way to discuss them is by location, because the three places an incision might sit on a given patient behave quite differently. The columella, the alar base, and — for cases using autologous rib cartilage — the harvest site on the chest each heal on their own timeline and respond to their own kind of care. This page covers what happens at each of these sites specifically: where the incision goes, how it typically behaves over the following months, and what is generally advised while it settles.

It does not explain why alar base reduction is performed as a procedure, which is covered on its own page, and it does not explain rib cartilage harvest as a surgical technique, which has its own detailed guide. It also does not cover swelling more broadly, which follows a different timeline from scar maturation and is addressed separately.

Why rhinoplasty scars need to be discussed by location

Not every rhinoplasty produces the same set of scars, because not every rhinoplasty uses the same approach or the same material. An open approach, which gives the surgeon direct visibility of the tip cartilage during more complex reshaping, leaves a small external incision at the columella. A closed approach, working entirely through incisions inside the nostril, leaves no external mark at all. Alar base reduction, a separate step used when the width of the nostrils needs to be narrowed, adds its own incision at the base of the nose. And when a patient's own septal cartilage is not sufficient for the plan, rib cartilage harvested from the chest adds a scar in a different part of the body entirely. Whether any of these apply to a specific case depends entirely on the diagnosis and the plan built around it — not every patient has all three, and some patients have none beyond the internal incisions that leave no visible trace.

What a closed approach means for scarring

It is worth being specific about the alternative, since patients researching scarring often assume every rhinoplasty must involve an external incision somewhere. A closed approach places every incision on the inside surface of the nostril, where the internal lining is not visible from any external angle once healing is complete. This approach is not automatically better or worse than an open one — it is chosen based on what the diagnosis requires, since some tip work genuinely needs the direct visibility that an open approach provides. But for patients whose plan does not require that level of access, a closed approach means the columella scar described below simply does not apply to their case at all. Whether an open or closed approach is appropriate for a given nose is part of what is decided during the diagnostic stage of a first consultation, based on the structural findings rather than a general preference either way.

The columella scar

In an open rhinoplasty, the columella incision is a small, precisely placed cut across the narrow strip of skin between the nostrils, usually shaped in a zigzag or stair-step pattern rather than a straight line. That shape is deliberate: a broken line across this kind of skin tends to heal less conspicuously than a straight one, because it distributes tension across several shorter segments rather than concentrating it along one continuous edge.

In the earliest weeks, the columella incision is typically pink or slightly raised — a normal part of any healing scar — and it is one of the areas examined directly at the two-week and one-month follow-up visits. Over the following months it generally flattens and lightens, and for most patients it becomes difficult to notice without deliberately looking for it, tucked as it is in a natural fold between the nostrils that is not typically visible from a straight-on view.

The alar base scar

When alar base reduction is part of a plan — typically to narrow flared or wide nostrils — the incision is placed at the base of the nostril, in the natural crease where the nostril meets the cheek. This location is chosen specifically because that crease already exists on every face; a scar placed inside it tends to hide within a shadow line the eye already expects to see, rather than crossing skin that would otherwise be smooth. For most patients, this makes the alar base scar one of the more forgiving locations on the face for a healing incision, though — like any scar — it passes through a visible, slightly firm stage before it settles. The mechanics of the reduction procedure itself, including when it is combined with other steps and when it is kept separate, are covered on their own page.

The rib cartilage harvest scar

Not every rhinoplasty uses rib cartilage — it is one option among several autologous materials, chosen when the septum does not provide enough usable cartilage for the plan. When it is used, the incision at the harvest site is kept deliberately small, roughly 2cm, placed to access the cartilage with as little disruption to the surrounding tissue as possible. For these cases, sutures are removed at 14 days, the same point at which ear cartilage sutures are removed when that material is used instead.

Because the rib harvest site is on the chest rather than the face, it heals in skin with different tension and movement characteristics than facial skin, and it is monitored as its own site at follow-up visits rather than assumed to behave the same way the nasal incisions do.

How scar appearance changes over the first year

Scar maturation follows a broadly predictable arc across all three sites, even though the pace and the final result differ by location and by individual. In the first few weeks, an incision is typically pink, slightly raised, and firm to the touch — this is a normal part of the body laying down new collagen at the wound, not a sign of a poor outcome. Over the following two to three months, most scars begin to flatten and the colour starts to shift from pink toward a tone closer to the surrounding skin. By six months to a year, scars are generally at or close to their mature appearance, though full maturation — the point at which a scar stops changing altogether — can continue somewhat longer in some individuals.

This timeline runs alongside, but separately from, the swelling timeline covered elsewhere on this site. A nose can have finished the bulk of its swelling while its scars are still visibly working through this earlier, pinker stage, and the two should not be read as the same clock.

It is also worth noting that scars generally look their most conspicuous somewhere in the middle of this process rather than right at the start. In the first week or two, an incision is often partly obscured by swelling, tape, or general redness across the whole area, so it does not stand out as a distinct feature. Once that general puffiness clears — but before the scar itself has had months to soften — the incision line can briefly look more prominent than it will end up being, simply because it is now the clearest thing left to notice on an otherwise settling nose. Patients who are caught off guard by this stage are usually reassured to learn that it is a normal, temporary part of the same arc rather than a sign that healing has stalled.

What is generally advised while a scar is settling

• Sun protection. Ultraviolet exposure on a healing incision can prolong redness or darken pigmentation at the site, and this applies to all three locations — the columella and alar base as much as the chest.
• Avoiding unnecessary tension or friction at the site while it is still in its early, less resilient stage, including picking at or aggressively cleaning a healing incision.
• Following the specific guidance given at your own follow-up visits rather than a generic scar-care routine, since the right approach can differ by skin type, by site, and by how a particular incision is healing.
• Reporting anything unusual promptly — a scar that becomes increasingly raised, itchy, or thickened well past the point where it should be settling is worth having examined rather than treated at home indefinitely.

Why scar outcome varies between patients

Two patients can have the same incision, placed the same way, and end up with visibly different scars — and this has more to do with individual biology than with anything different about the surgery. Skin type and thickness, natural pigmentation, a personal or family tendency toward raised or thickened scarring, and simple individual variation in how quickly and how completely a given person's tissue remodels all play a role. Thicker, oilier skin types tend to hold redness a little longer at the site, while thinner, drier skin often shows the early pink stage fade somewhat faster but can be more prone to visible fine-line texture in the incision itself. Neither is a better or worse starting point overall — they are simply different healing patterns that call for different expectations about timeline.

This is also why "scar care" is not a single universal product or routine — what helps one patient's healing is not automatically the right approach for another, which is part of why guidance on this is given individually at follow-up visits rather than handed out as a one-size instruction sheet. A patient with a personal or family history of raised or thickened scarring is worth flagging at the consultation stage specifically, since that history can shape both the surgical approach and the follow-up care plan from the outset rather than being addressed only after a scar has already started to heal in an unexpected way.

What we do not promise

No rhinoplasty incision heals into completely invisible skin, and any description that suggests otherwise is not an accurate one. What can honestly be said is that the incisions used in rhinoplasty are chosen and placed specifically to minimise visibility — through their location, their shape, and their small size — and that most patients find their scars fade to the point of being genuinely difficult to notice in ordinary daily life. That is a meaningfully different claim from "no scar," and it is the one that reflects what surgery actually does.

About the medical reviewer

Dae-hee Han, MD — Board-Certified Plastic Surgeon (specialist certificate No. 2045, issued 3 March 2014; medical licence 00394, issued 26 February 2009). Master’s degree, Ajou University School of Medicine. Training at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan (2013), and the IFAAS Mini Fellowship, University of Florida, USA (2016). Three rhinoplasty papers published in SCIE-indexed international journals. More than 4,500 nose surgeries — Dr. Han’s career total from 2017 to 2025, counted from medical records. He carries out consultation, surgery and follow-up personally; fee guidance is given by the clinic’s consultation manager.

Last reviewed: 2026-08-15

Clinic information

Edition Plastic Surgery Clinic & Dermatology
6F, OPUS 407, 407 Gangnam-daero, Seocho-gu, Seoul 06614, Republic of Korea
One minute on foot from Gangnam Station Exit 10
Tel +82-2-591-0100 · editionprs@gmail.com
Consultation hours: Monday to Friday 10:00–19:00 · Saturday 10:00–17:00 · closed Sundays and public holidays

Disclaimer

Individual results may vary. Bleeding, infection, swelling, asymmetry, and scarring can occur. Please decide after a full consultation with a board-certified specialist.

This page is general medical information. It is not a diagnosis, and it does not promise a particular outcome. Surgical fees are given after an in-person consultation.