Columella Scar Following Rhinoplasty

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

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.

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.

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.

Hi Kelly,

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.

Dr. P

If the step-off is the only aspect of your rhinoplasty that you are concerned with, I would choose the same surgeon as this could be done under local and would likely be inexpensive or free of charge.  If there are other aspects that are unsatisfactory, it would be wise to address them with your current physician.  If you are unsatisfied with the information that you attain, seek an additional opinion.  The scar revision is a minor procedure.  Good luck!

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...

Kelly,

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.

Kelly,

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.

An open rhinoplasty leaves usually a small almost imperceptible scar on the columella. If the scar is pinching or "looking wonky" then it could be a very simple procedure to revise the scar.