How do you have your patients care for the incision after stitches are removed?

Question

I'm seeing conflicting information about how to care for the columella incision once stitches are removed. The surgeons I'm looking at all remove stitches after a week. What do you have your patients do once stitches are removed? Leave it dry? Keep it moisturized? Just clean and apply vaseline every day? Or do you recommend scar gel? Or silicone sheets? Do you recommend massages or is it better not to touch it? Want to do whatever I can to minimize scar visibility!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The incision from open rhinoplasty should heal in a completely unnoticeable manner. I have my patients apply bacitracin for the first two weeks after surgery and then switch over to biocorneum. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Lucian Ion, FRCS · Answer

Hello,

Thank you for your question regarding the care of the columella scar following the removal of sutures.

Here are some suggestions to help you care for your scar:

1.	Silicone Applications: It is important to wait at least 3 weeks after the intervention before starting silicone applications. Applying silicone too early can cause problems with the healing process.
	2.	Moisturizing the Scar: Keeping the scar moisturized can significantly aid in the healing process. Vaseline is a good option to keep the area hydrated. Bepanthen cream is also helpful as it promotes healing.
	3.	Avoid Massage in Early Stages: It is crucial to avoid massaging the scar in the early stages of healing. Massaging too soon can disrupt the incision and increase the risk of infection.
	4.	Gentle Care: Gentle care is more valuable than aggressive massage. While there are various scar management preparations available, ensuring that you treat the area gently will help support optimal healing.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jeffrey H. Spiegel, MD · Answer

Removing columella incision stitches is very uncomfortable.  I've used dissolving sutures for many years and the scars heal nearly invisibly. No aftercare needed.

Eric M. Joseph, MD · Answer

We utilize an external approach for nearly all of our rhinoplasty surgery procedures, and after 25 years, we have not had any keloid scarring in any of our patients. Additionally, we have not seen keloid scarring at the base of the nose in patients who had rhinoplasty surgery performed by other surgeons. When it comes to keloid scarring, it's like real estate. Location, location, location. The base of the nose is one of those areas that just heals really well and does not require silicone sheeting or other intervention. Thank you for your question. Sincerely, Dr Joseph

Jeffrey M. Darrow, MD · Answer

The columella incision, which can be closed with dissolving sutures or permanent sutures that need to be removed, typically heels exceptionally well and is very well camouflaged given time. The most important care is to simply keep the area clean of any dried blood and allow the tissues to heal and the incision to mature.  I do not recommend scar gel. I also don’t recommend silicone sheeting as it’s very difficult to keep a silicone sheet on the under surface of your nose without it being conspicuous. Massaging is not necessary as this incision typically heals exceptionally well. Best wishes.