I have a many rhinoplasty patients who consult with me in my Los Angeles plastic surgery office, who have shopped around for their surgeon before making their very important decision on who will perform their rhinoplasty. One surprise that I enjoy is the relief on the patient’s face when they ask about how the scar from surgery will look, and I tell them that there won’t be any scar. “But Dr. So-and-so told me that he had to cut between my nostrils to do my rhinoplasty,” they reply. What they are referring to is external or open rhinoplasty, where an incision is made in the columella, or the skin between the nostrils, which allows a surgeon to flip the skin back so they have a better view and access to the cartilage and bone of the nose. It’s the technique that most surgeons trained in the last 15 years learn in their training, because you can see what the teacher is doing.

But there is a problem with open rhinoplasty: the scar. It is usually acceptable, but occasionally it is noticeable. I can usually see some trace of it in almost everyone who has open rhinoplasty, especially if they have thicker skin. How do you avoid this telltale scar? I perform scarless rhinoplasty by making all my incisions inside the nose. This is the original way that rhinoplasty was performed, but less experienced plastic surgeons shy away from it because it is more difficult, and it is hard to learn. From a patient’s standpoint, however, it is very reassuring not to have a scar on their nose that might draw attention, especially since many patients seeking rhinoplasty because they are self-conscious of their nose already.