Im planning to have revision rhino n was advised by the Dr.V & was advised rib cartilage.I have scar from previous surgery on my columella(stiches line&keloid at the bottom).Dr.V advised to wait til revision is fully heal to consider scar revision.He will incise at the middle (horizontal) of my columella for the revision.My previous doc. is against rib cartilage&told me that scar in rhinoplasty is normal& some(like me)are more prone to scar.He said incision should be at the bottom as previous.
Revision Rhino for Scarred Columella
Doctor Answers 9
Revising columellar incision scar
If you're planning on a revision rhinoplasty procedure it is more standard to use the prior incision and revise the scar at the same time.
Without seeing your nose it's difficult to give a full assessment of this though.
Choice of incisions with revision
without seeing your pictures it is very hard to give you accurate advice but , in general, it is common practice to use the existing incisions instead of making new ones.
If a cartilage graft is needed, the Surgeon should use the previous incision because if a more anterior incision is used there is a good possibility that the tissue between the old scan and new incision will die.
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Many noses are more safely and accurately revised by closed rhinoplasty
Although open rhinoplasty is very common, it t has significant drawbacks. All the modern techniques can be done through the inside (closed), and many were originally designed to be done that way.
My research presented at the annual meeting of the American Society of Aesthetic Plastic Surgeons shows that patients seeking revision rhinoplasty who were originally treated by open rhinoplasty have more deformities than those who were originally treated closed, and their deformities are more severe.
The open surgeon has the disadvantage of not being able to see the nuances of nasal shape, or able to see the adjustments that may need to be made because the skin is out of position.
For these reasons, it is often better to revise a previous open surgery by a closed rhinoplasty; it is safer, adds no new scars, and is much less of a stress on the nasal circulation.
When postoperative problems are the result of a particular technique, their correction will be better achieved by a technique that does not have the same drawbacks.
Revision Rhinoplasty with Scarred Columella
With all due respect for your surgeon, I would do the revision surgery through the previous incision and revise the scar at the same time rather than make a new incision.
Scar at columella
The columella scar usualy heals quite well after rhinoplasty, but I would give it time( at least a year usually) before considering a revision.
Revision of Columella Scar
Waiting for things to settle down for 6-12 months after any rhinoplasty operation is a good practice. The need for cartilage, rib or other, is often a choice made best by an experienced surgeon in consultation with the patient. Without photos and a more detailed history we can't call that here. A columellar scar after an incision is expected up to a point. It sounds like you have a hypertrophic scar, which may settle down over time. A revision of the scar can be done if indicated after a year or so. keloids on the nose are extremely rare. As far as placement of the incision, if a low incision is already present it may be wise to use that again. If a higher incision is made the blood supply to the skin may not be adequate, and skin loss may occur. Discauss all these points with your surgeon until you are comfortable with the plans.
Revision Rhinoplasty and Scarred Columella
I think that it is wise to wait until things are healed prior to performing a revision. I like to wait at least one year before reoperating on a nose, particularly if it is a complicated revision that will require grafting. If restructuring of the nose or augmentation is needed, my personal preference is to use rib cartilage if a lot of tissue is needed and when septal cartilage is not available. i stronly believe this is the best grafting material available to us for revision rhinoplasty. As far as the columellar scar is concerned, if you require a revision, the incision has to be done exactly where the scar is. The scar is excised and a newer (and hopefully better) one is created. There is no other option. Good luck.
Dr. Andres Gantous
Keloid on Columella
If I understand your problem correctly, you have a keloid scar on the columella and have lost support for the tip of your nose requiring a rib graft to repair. Waiting at least 6 months after your last rhinoplasty is always good advice. Keloids can be treated in the meantime with steroid injections. You will be at risk for another keloid if you have surgery again, and injection with steroids beginning one week after surgery can be helpful. For support of a collapsed nose with a lack of tip support, the most reliable choice is a rib graft. If you have remaining cartilage and bone in your nasal septum, this is another choice for a graft for your nose. Without pictures, that is the best advice that I can offer.