In short. Crease, base or sill: what each placement exposes to view, who tends to end up with a visible line, and how pigment behaves in skin that tans easily.
Key points
- Ask which part of your base is being narrowed and the placement answers itself.
- Flare is a rim problem and takes a crease line.
- A broad floor takes a line along the base.
Placement is the decision in this operation, and it is made before the operation rather than during it. The same amount of narrowing can be bought with a line in the crease, a line along the base, or a line across the sill, and what each exposes to view from the front and the side is different.
Three placements and what each exposes
In the crease where the nostril meets the cheek, the line sits in an existing shadow and is the least visible of the three. Along the base of the nostril, the line is angled so that it faces downward, which hides it from above but leaves it partly visible from the front in strong light. Across the sill, between the nostril and the upper lip, the line faces forward and is the most exposed of the three. None of them is hidden by anything.
Placement follows anatomy, not preference
Ask which part of your base is being narrowed and the placement answers itself. Flare is a rim problem and takes a crease line. A broad floor takes a line along the base. A sill that runs outward takes an extension towards the lip. A clinic that offers the least visible placement regardless of your anatomy is offering you its preference rather than your plan.
Who tends to end up with a visible line
Three factors do most of the work. Skin that tans easily holds pigment in a healing line for longer, so the line stays noticeable well past the point at which other patients have stopped seeing it. Thick skin near the nostril can produce a raised or wide scar more readily than thin skin does. And a patient who has healed badly elsewhere, whether after a previous operation, an injury or a piercing, has information about their own scarring that belongs in the assessment rather than in the recovery.
How the line reads against the nostril
A scar is judged in context rather than on its own. A line that follows the natural curve of the nostril reads as part of the nostril; one that cuts across the curve reads as a mark. This is why placement and direction matter more than length, and why the first year is spent watching the line soften and blend rather than measuring it.
Get these answered before the operation
- Where exactly will the line sit on my face, and how will it look from the front?
- How has my skin scarred before, and is anything in my history a reason to expect a wider or darker line?
- What is the plan if the scar matures badly, and at what point would that be considered?
Scar care, sun protection and the products used along a healing line are covered by the hospital’s scar material rather than here. What belongs here is the choice that cannot be revisited: once a placement is used and the tissue is removed, the line is where it is.
Frequently asked questions
Which placement gives the least visible scar?
The crease, where the nostril meets the cheek, because a natural shadow already falls along it. It is also the placement that addresses flare rather than width across the base, so it is chosen for the anatomy rather than for the scar. A crease line used to fix a broad base does not fix a broad base.
Why does my scar look worse at three months than at three weeks?
Because a scar matures in a predictable sequence, and redness and firmness usually peak somewhere in the second and third month before settling. The early weeks look better than the middle ones for most people. Judging the line during that window is the commonest reason a patient becomes alarmed by a scar that goes on to mature well.
Does darker skin mean a worse scar?
Skin that tans easily tends to hold pigment in a healing line for longer and to mature more slowly, so the line stays noticeable for a longer period. It is a difference of duration rather than of kind, and it is one of the few things about scarring that can be discussed in advance with reasonable confidence.
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.