Columellar Incision Scars in Asian Patients Undergoing Open Rhinoplasty

Overview

Open rhinoplasty gives wide, undistorted access to the nasal framework, and its main drawback is a visible scar across the columella. The authors reviewed 529 patients operated at a tertiary centre in South Korea between January 2011 and May 2014 to establish how often problem scars occur, how they evolve and what makes them more likely.

Sections of note

• 529 patients, 176 female and 353 male, mean age 31, range 5 to 70.
• 234 patients with at least six months of follow-up were evaluated for problem scarring.
• 14 of 234 (6.0 percent) had a problematic scar: wide and depressed 4 (1.7 percent), notching 3 (1.3 percent), hyperpigmentation 4 (1.7 percent), hypertrophic scar at the marginal incision 2 (0.8 percent), and skin necrosis of the columella 1 (0.4 percent).
• Among 243 patients evaluated for redness, almost all had red wounds immediately after surgery.
• Redness normalised after a mean of 66.7 days, standard deviation 37.4.
• Using rib cartilage as tip graft material was associated with problem scarring: 2 of 25 patients (8.0 percent) against 6 of 180 (3.3 percent) with other graft material, p = 0.02. Level of evidence 4.

What it means for a patient

• The scar under the nose is red for roughly two months on average before settling.
• Six in a hundred patients had a scar problem, most commonly a widened, depressed or darkened line.
• One patient in the series lost skin at the columella, which is the most serious of the outcomes recorded.
• Retrospective, single centre, and fewer than half the operated patients had enough follow-up to be assessed, which may bias the rate in either direction.

Why this paper matters

The columellar scar is the standing objection to the open approach and is often discussed without data. Putting a rate on it in a specific population, and identifying rib cartilage grafting as a risk factor, gives the consent conversation numbers. The authors conclude the low rate is not a reason to avoid open rhinoplasty.

Terms

• Columella: the strip of skin between the two nostrils.
• Transcolumellar incision: the small cut across that strip used in open rhinoplasty.
• Hyperpigmentation: darkening of the skin at a scar.
• Hypertrophic scar: a raised, thickened scar.
• Necrosis: death of tissue from loss of blood supply.
• Erythema: redness of the skin.