In short. Swelling leaves in months and the scar takes a year or more. What can be judged at each stage, why the base looks uneven early, and when to raise a concern.
Key points
- The two sides were not symmetrical to begin with, the swelling does not sit evenly on them, and the scar on one side may mature slightly ahead of the other.
- Early unevenness is therefore the expected state rather than a warning.
- What is worth noting is a difference that is increasing rather than settling, because that is a different pattern.
Two things are settling at once after this operation, and they run on different clocks. Swelling in the base and the rim largely resolves over months. The scar takes up to a year and sometimes longer. Almost every worry patients bring to a follow-up falls into one of the two.
What can be judged early
Very little about the appearance, and rather more about the recovery. In the first fortnight what matters is whether the wound is healing cleanly, whether the stitches come out on schedule, and whether breathing is as expected for the stage. By the end of the first month the surface has healed and the base feels firm, and the honest answer about the shape is that the swelling is still in charge.
Why the base looks uneven early on
The two sides were not symmetrical to begin with, the swelling does not sit evenly on them, and the scar on one side may mature slightly ahead of the other. Early unevenness is therefore the expected state rather than a warning. What is worth noting is a difference that is increasing rather than settling, because that is a different pattern.
The middle months, when the scar is loudest
Around the second and third month the shape usually begins to please and the scar is at its most noticeable. The line is red, firm and raised, and it is more visible than it was at three weeks. The shape underneath it is usually ahead of the scar, which is why the two impressions disagree. Patients frequently conclude at this point that something has gone wrong, when in fact they are looking at the least flattering stage of a normal sequence.
What to raise, and when
A concern is worth raising rather than waiting out when it has a shape rather than a stage: a notch at the rim that you can feel, a difference between the sides that is widening, an opening that pulls inward on breathing in, or a line that is thickening beyond the surrounding skin. Concerns about appearance alone are usually better held until the swelling has gone and the scar has had at least a year.
Why the scar settles last
The scar is the last thing to stop changing, and it is the thing you look at most. Its colour fades, it flattens, and it gradually blends towards the skin around it, but the process is slow and it behaves worst in skin that tans easily. Judging the operation by the line at six months is judging the longest part of the recovery before it has finished. Nothing about the result can be read from the line before then.
Do not let a stage be read as a result
- A judgement of the final shape offered while the swelling is still in the base.
- A scar plan begun without anyone saying how long the line is expected to keep changing.
- A decision about a second operation taken while the first one is still maturing.
Frequently asked questions
What can honestly be judged about the base at six weeks?
The recovery rather than the result. Whether the wound is healing cleanly, whether the stitches came out on schedule, and whether breathing is where it should be for that stage. The shape cannot be read yet, because the swelling is still substantial and it is not sitting evenly on the two sides.
Why does the base look more uneven at two months than at two weeks?
Because the swelling that hid the difference has begun to leave while the scar is still firm and raised, and the two sides do not mature at exactly the same rate. The middle months are the least flattering stage of the sequence for most patients, and the unevenness usually settles from there.
At what point should an unevenness be raised instead of waited out?
When it has a shape rather than a stage: a difference between the sides that keeps growing, a notch you can feel at the rim, an opening that pulls inward when you breathe in, or a line thickening beyond the skin around it. A concern that is purely about appearance is usually better held until the scar has had a year.
Risks & Limitations
- The scar is the mechanism of this operation rather than a complication of it. It stays, and it matures over a year or more.
- Tissue removed from the alar base does not come back, so over-narrowing is difficult to correct.
- The nostril opening is part of the airway. Narrowing it can reduce breathing, and function comes before width.
- The two sides are rarely symmetrical to begin with, and a scar behaves worst in skin that tans easily.
When to Seek Care
- Difficulty breathing through the nose that is worsening rather than settling, or breathlessness at rest.
- Fever with spreading redness, warmth or discharge around the incision.
- Bleeding from the incision that does not stop with gentle pressure.
- A nostril that pulls inward when you breathe in, or an edge that is becoming notched or tethered.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.