Columellar Scar Perception in Open Rhinoplasty. Interplay of Scar Awareness, Body Cathexis and Patient Satisfaction

Overview

Open rhinoplasty leaves a small scar across the strip of skin between the nostrils, and this is routinely cited as the approach's main drawback. The authors tested how many patients actually notice it and whether noticing it affects how satisfied they are with their nose or how they feel about their body generally.

Sections of note

• 91 patients who had undergone open rhinoplasty were included.
• A written questionnaire of 4 sequential questions was used; the first asked whether the patient had any facial scar from trauma, surgery, or another cause, and the rest were scored 1 to 5.
• Two instruments were applied: the 25-question Modified Body Cathexis Scale and the Columellar Scar Assessment Scale.
• 12 of 91 answered yes to the first question by reporting their columellar scar.
• Patient satisfaction did not differ significantly between those who reported the scar and those who did not, p greater than 0.05.
• Those who reported the scar had significantly lower Modified Body Cathexis Scale scores.
• 9 patients said they made an effort to conceal their scars, and satisfaction differed significantly between concealers and non-concealers.
• Scar assessment scores were significantly higher in those who reported the scar. Level of evidence IV.

What it means for a patient

• Most patients in this group did not name the columellar scar when asked openly about facial scars.
• Noticing the scar tracked with a person's broader feelings about their body rather than with regret about the surgery.
• Those actively hiding the scar were a distinct group whose satisfaction did differ.
• Limits: 91 patients, one center, questionnaire based, no comparison with closed rhinoplasty patients, and no stated time since surgery.

Why this paper matters

The columellar scar is the standard argument against the open approach, and this measures how much patients actually register it. It shifts the question from scar quality toward how a person relates to their own body.

Terms

• Columella: The strip of skin between the nostrils, where the open rhinoplasty incision is placed.
• Body cathexis: How positively or negatively a person feels about their own body.
• Modified Body Cathexis Scale: A 25-question instrument measuring that feeling.
• Columellar Scar Assessment Scale: A grading scale for the appearance of that scar.
• Open rhinoplasty: Surgery using that external incision to expose the framework.