I am 6 months post open Rhinoplasty and am really unhappy with the appearance of the columella scar. There is a noticeable step on each side, one side more so than the other. The nose looks 'wonky' and one nostril also appears slightly larger than the other. My surgeon has agreed to undertake a small half-hour scar revision procedure but I am doubtful that this will address all my concerns. Also, should I be considering going under the knife again with the same consultant?? Thanks K
Columella Scar Following Rhinoplasty
Doctor Answers (13)
Revision for columella scar?
A beautiful columella scar requires meticulous attention to detail when closing the wound. If the skin isnt perfectly aligned, and if the dead space within the wound isnt filled (which is why I use a two layer closure) noptching and step offs occur. I agree with having a revision performed by the same surgeon to correct it.
The photo is dark so I can't see the scar as well as I might like but if you don't like other aspects of your result, revising the scar won't fix those. Your tip looks round and might possibly have gotten more definition in your open rhinoplasty. But I don't know if this isn't a great improvement from preop because we don't have a photo of that.
Nose Scarring after Rhinoplasty
Columellar scars almost never heal bad. Your situation is specific in that the actual scar healed well but becasue the sides were not approximated accurately, there are noticeable step offs. If you are happy with the rest of your nose, you may want to consider the same surgeon. This will save you time and money. Furthermore, the revision for this is fairly simple but your columella in general will look better if the base of it was narrowed. This requires soft tissue to be removed between your medial crural footplates (cartilage in the columella) and for suturing techniques to re-shape it. Fixing the skin itself is failry simple though.
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The columella scar across the base of the nose typically heals well after open Rhinoplasty,
and the open approach allows for greater attention to detail in correcting any changes that are desired in the nasal tip. It is also my approach of choice for patients whoo have already had a Rhinoplasty and want a revision, where the normal anatomy has already been changed surgically. If the scar remains prominent or uneven after sufficient time has passed, and there is no improvement with massage or injection techniques, than a revision of the scar should improve the appearance. If that is really your only concern, I would return to your original surgeon for a revision of the scar as planned. If you have other concerns about the appearance of your nose, I would get a second opinion. You can always go back to your original surgeon after getting another opinion, and this could help alleviate some of the anxiety you are feeling...
I looked at your photographs. I would have the same surgeon revise the scar. Most of the time this type of stepoff scar is easily corrected.
Rhinoplasty - columella scar
I looked at your photo and agree that there are step offs. This is surprising as columellar incisions usually heal with an almost invisible line. This should be relatively easy to fix and could be done under local anesthesia. Most nostrils are not completely identical even on non-operated patients and based on your photo - they are not significantly different from each other. As to whether or not to return to your plastic surgeon - this is personal decision you will have to make based on your relationship with him or her. In almost all cases, plastic surgeons will do revisions on their patients and not charge you a surgical fee.
Dr. Cat Begovic M.D.
What to do with cars under my nose
Dear Kelly from white plains,
I reviewed basal view of your nose pictures, I agree that there are step-offs on both sides. However the incision site has healed well. If the step-offs are your main concerns after your initial rhinoplasty, I would recommend seeing your own surgeon to correct them. This could be performed under local anesthesia with no charges to you.
Your columella scar after Rhinoplasty Surgery may be improved.
I read your concerns and reviewed your photo. If you have other concerns about the appearance of your nose that would require surgery, then you should not undergo an in-office scar revision. Since you're having concerns about your rhinoplasty surgeon, please see several reputable rhinoplasty specialists to see what would be best for you. Feel free to email your photos along with a description, and I'll be happy to share my thoughts with you.
If the "step off" was your only concern, I would personally consider an injection of Silikon-1000 into the notch on each side rather than a scar revision.
I hope this is helpful for you.
Revision Rhinoplasty of Columellar Scar
You should be sure that your rhinoplasty surgeon understands your concerns and feels that he/she can accomplish the correction. If you are confident in your surgeon then it isokay to have the revision by the same surgeon. If not choose another surgeon carefully whom you trust. It may be a good idea to get a few second opinion consultation either way. Good luck and be well, hope that you get the nose that you desire.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.