Rhinoplasty does leave scars, but whether you can actually see them depends almost entirely on the surgical technique used. In most cases, incisions are placed inside the nostrils or along natural creases where they become virtually invisible once healed. Raised or noticeable scarring occurs in fewer than 1.5% of rhinoplasty patients, according to a systematic review of adverse events after the procedure.
Where Incisions Are Made
There are two main approaches to rhinoplasty, and each one places incisions in different locations.
In a closed (endonasal) rhinoplasty, all incisions are made inside the nostrils. Even though these incisions encircle nearly half of the nostril lining, no part of the cut is visible from the outside. This approach leaves no external scar at all.
In an open rhinoplasty, the surgeon makes the same internal incisions but adds a small bridging cut across the columella, the narrow strip of tissue between your nostrils. This external segment is only about 4 to 5 millimeters long. In exchange for that tiny visible mark, the surgeon can fold the nasal skin upward and get a much clearer view of the structures underneath. The trade-off is greater precision during complex reshaping, with a scar that typically fades to a faint, pale line within several months.
Scars From Nostril Narrowing
If your surgery includes narrowing the nostrils (alar base reduction), there will be an additional incision where the nostril meets the cheek. Surgeons place this cut in the natural crease at the junction of the nostril and face, which helps the scar blend into a fold that already exists. Research comparing different placement strategies found that incisions made directly in this groove heal with better scar outcomes and are more effectively hidden, particularly in patients who have a deeper crease in that area. If the incision is placed even 1 to 2 millimeters away from this groove, the scar tends to be more noticeable.
How Skin Tone Affects Healing
People with darker skin tones face a slightly different healing timeline. The columellar incision or any external cut can develop temporary darkening around the scar, a form of post-inflammatory pigmentation. This discoloration typically resolves within 3 to 6 months with consistent sunscreen use. Without sun protection, that pigmentation can linger much longer.
Darker skin is also more prone to raised scarring in general, including hypertrophic scars and keloids. If you have a personal or family history of raised scars, that’s worth discussing before surgery so your surgeon can plan the approach and aftercare accordingly.
Internal Scarring You Can’t See
There’s another type of scarring that has nothing to do with appearance. Inside the nose, scar tissue can form between surfaces that are healing in close proximity to each other. These internal adhesions, called synechiae, are bands of fibrous tissue that bridge the gap between the nasal septum and the inner walls of the nasal cavity. They’re a natural byproduct of the healing process, but when they form in the wrong spot, they can partially block airflow and make your nose feel congested.
Studies on nasal surgery report that clinically significant adhesions affect anywhere from 4% to 36% of patients, though that wide range reflects differences in surgical technique and the extent of work done inside the nose. Procedures that address both the septum and the turbinates (the internal structures that regulate airflow) tend to produce fewer adhesions than septum work alone. Your surgeon will check for these during follow-up visits in the weeks and months after surgery, and they can usually be addressed in the office if they develop.
What Affects How Your Scar Heals
Even with perfect incision placement, the final appearance of any external scar depends on how your body heals. A systematic review of rhinoplasty complications found that hypertrophic scarring, where the scar becomes raised and thickened, occurs in 0% to 1.5% of patients. That’s a low rate, but it’s not zero.
Several factors influence your outcome. Genetics play the biggest role: some people simply produce more collagen during wound repair. Tension on the incision site, infection, and sun exposure all increase the risk of a more visible scar. Smoking restricts blood flow to healing tissue and consistently worsens scar quality.
Caring for Your Scar After Surgery
Sun protection is the single most important thing you can do for any external scar. Scars that get sunburned can remain red and discolored for a very long time, potentially permanently. Apply sunscreen to the area daily, and use a hat when you’re outdoors for extended periods, especially in the first year.
Silicone-based products are the best-studied topical treatment for scar management. Silicone gel, applied once or twice daily, helps raised scars flatten and lose redness faster than untreated scars. Silicone sheets or tape, worn continuously and removed only for bathing, work on the same principle. Either form should be used for at least 3 to 4 months, and longer if the scar is still red or elevated.
Gentle massage of the scar, once it’s fully closed, can also help soften and flatten the tissue over time. You can use vitamin E oil, cocoa butter, or a basic moisturizer during massage. Expensive scar creams marketed in drugstores and online have no strong evidence of improving scar quality beyond what massage alone provides.
Options if a Scar Stays Visible
For the small percentage of patients who develop a noticeable scar, several laser treatments can improve its appearance. Pulsed dye lasers are the most commonly used option for raised or red scars, targeting the blood vessels that give hypertrophic scars their color. Fractional lasers, both ablative and nonablative types, work by creating microscopic channels in the scar tissue to stimulate new collagen production and smooth out texture. A split-scar study found that fractional laser resurfacing produced better results than fully ablative treatment for surgical scars.
Timing matters. Some laser treatments are most effective when started within 6 to 10 weeks after surgery, while others are used on mature scars that have had a full year to settle. Multiple sessions are typically needed. For persistent raised scars that don’t respond to laser alone, steroid injections can help flatten the tissue.