4 weeks post op, what can I expect from columellar scar? (photos)

The flap of columellar skin was elevated and the skin posterior to the incision (closer to your lip) was not. Thus the former skin is swollen and the latter is not. Therefore there is a slight 'step' at the incision line and this is due to swelling. All incisions look their worst around 6 weeks post operatively so I feel things will ultimately look just fine. Follow up with your surgeon as there are several adjunctive things that might be helpful if there are concerns such as laser, silicone sheeting or gel, kenalog injections, steroid impregnated tape etc...

Thank you for the question and the photos.  Most incisions look at their worst right about 4 weeks since collagen buildup its at its highest right around then.  Swelling is also a factor for you since your columellar incision is a little closer to the lip junction than usual and therefor further from its blood supply.  I think in the end the incision is going to heal quite nicely.  It may take a little longer than usual but definitely know that quite a bit of time is needed for significant healing to occur.All the best,Dr. Remus Repta

Dear Jodizjz, Personally I make my external incision notched (not straight) and higher on the columella towards the tip, not so close to the lip junction for better healing. This incision typically heals very well and is unnoticeable to most eyes after a few weeks recovery. I would follow up with your surgeon and discuss your concerns and he/she can monitor your recovery closely. Best regards, Michael V. Elam, M.D.

In the vast majority of Rhinoplasty cases, the columellar heals extremely well.  Follow up with your Plastic Surgeon in the next couple of weeks to address your concern.