Columella Scar 1 year post rhinoplasty - can this be made to be less noticeable? (Photos)

Question

I am 1 year post open rhinoplasty & it has been a journey to say the least. Aside from the persistent nasal tip swelling, I also have this columella scar which has been daunting to get rid of. Since day one I applied silicone scar gel to the area and also used scar sheets. I more recently have been doing laser. Istarted off with clear and brilliant x2 sessions which helped, then did pico (did nothing), then as of 2 weeks ago tried fraxel which has given me the biggest improvement this far. I guess what my question is, is there a chance we can get the scar to be less noticeable and more blended? If so, what treatments should I try? Should I continue with fraxel and other modalities?

Anna Chacon, MD, FAAD · Answer

I understand how frustrating this can be, especially after a long recovery from rhinoplasty. You’ve already been diligent with silicone gel, scar sheets, and several laser treatments, so it makes sense that you’re hoping for the scar to blend more naturally with the surrounding skin.

Yes, a columella scar can sometimes continue to improve in texture, color, and visibility, even a year after surgery. However, the degree of improvement depends on whether the scar is primarily red or pigmented, raised, indented, or widened. Complete disappearance is unlikely, but making it less noticeable may be possible.

Since you’ve seen your best improvement with Fraxel, it may be worth discussing whether additional sessions are appropriate. Fractional laser treatments can help improve certain scar-texture irregularities, but more treatment is not always better. The correct settings, treatment intervals, and your skin type all matter, particularly because aggressive laser treatment can sometimes cause prolonged redness or unwanted pigmentation. I would allow the skin to recover fully from your recent session before deciding on another one.

Other treatments depend on the scar’s appearance:

Persistent redness: A vascular laser may help if visible blood vessels are contributing to the color.

Uneven texture or mild indentation: Fractional laser resurfacing may help gradually smooth the area.

A raised or thickened scar: A dermatologist or plastic surgeon may consider targeted treatments such as corticosteroid injections when appropriate.

A widened or poorly aligned scar: In selected cases, surgical scar revision may be considered, although revision can create another scar and should be approached cautiously.

I would also separate the scar concern from your persistent nasal tip swelling. Tip swelling can last longer than a year after rhinoplasty, but ongoing swelling should be assessed by your operating surgeon to determine whether it is part of the healing process or needs further evaluation.

My recommendation is to have the scar examined in person before committing to more laser sessions. Since Fraxel has helped, further improvement may be possible, but the best next step is to identify the specific characteristics of the scar and choose treatment accordingly. Patience is important here, and the goal should be gradual blending rather than trying to erase the scar completely.

Columella Scar 1 year post rhinoplasty - can this be made to be less noticeable? (Photos)

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