Hello, I had open rhinoplasty almost a week ago , it was revision rhinoplasty . The incision line on the columella became disconnected on the side and seems like it wont be healed evenly because it has nowhere to connect to lined up. Im very worried about it, it looks very bad like skin cut. I have spoken with my Dr. and he said its nothing to worry, but to me it looks like it wont be healed well and this peace of skin will stay noticable. Please tell me what should I do now and what to expect?
Disconnected Columella on One Side, Not Lined Up Evenly? (photo)
Doctor Answers 3
Columellar incision separation
You may have an area of separation of the incision line on the right side where you circled. The area may heal just fine on it's own and doing incision line care as instructed by your surgeon will help this along. A small scar revision can be done in the future if needed.
In some cases of incision line separation I'll place a small temporary suture to help bring the skin edges back together. Your surgeon is the best person to assess whether this would be a good idea.
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Healing of the open rhinoplasty incision
Thanks for the question and photo. It seems that you have a dehiscence or separation of a small portion of your open rhinoplasty incision. In all likelihood, this will heal quite well over the next few weeks, despite the separation. I typically advise my patients to put antibiotic ointment (Bacitracin) on the incision three times a day after surgery after all open rhinoplasty procedures. This helps to keep the incision moist and minimizes crusting. You can certainly ask your surgeon if this would be appropriate, if you are not already doing this.
In the long-term, a scar gel such as Kelo-Cote or Mederma may also help if the incision line looks more visible on that side. You may want to ask your surgeon about this option too. Overall though, I do not think this incision line will be a problem. If, for some reason, this does become an issue, your scar could be improved by either excising the old scar and closing it again (15 minute, in-office procedure under local anesthesia) or treating it with a laser.
Lastly, a quick background on this open rhinoplasty incision. I perform both open and endonasal (closed) rhinoplasty and have never had to revise this transcolumellar incision, even in the rare cases in which patients experience a slight separation like yours. In my opinion, for noses that require tip work, he improved access which can be had with the open approach is absolutely worth the faint, practically undetectable, tiny line on the bottom of the nose. This small incision should not deter patients from having an open rhinoplasty. Rather, patients should find a surgeon with whom they feel comfortable and whose before/after photos they like. Patients should ask for computer imaging during the consultation, to illustrate what the surgeon could do with the nose aesthetically. Finally, they should trust her or him to decide which techniques would be best for their unique issues.
Why dont rhinoplasty patients believe their doctors?
It seems to me the operating surgeon here and in most cases gives the patients very good advice. Many of the questions are disbelief of their surgeon who is the best one to understand their concerns. Are we simply not believable or dont we prepare our patients well enough. When a doctor on this line disagrees with the surgeon does the patient go running into the office like he has a smoking gun." See youare wrong and I was right all along"