Notched columella after revision rhino. What can be done to correct this? (Photo)

Question

I had a severe columellar deformity from an open revision rhinoplasty (stair step incision) and the surgeon tried to correct it multiple times with an ear cartilage graft, but it’s still uneven. What can be done to correct this? I’d appreciate a detailed answer with respect to the procedures that could possibly smooth this out.

Jeffrey Lisiecki, MD · Answer

It's tough to sufficiently answer this question based on one photograph, but based on your photo and description (and assuming you are far enough out from your latest revision), there are a couple possiblities. If the notching is just related to the skin and scar, a scar revision may be sufficient. If it is the result of insufficient structural support or volume in the infratip and columella, then adding more graft material to that area or changing the structure of the tip so that area is more supported would be necessary. If you are trying to avoid surgery and it seems to be just a volume issue in this area, then a revision with filler may be a reasonable (though probably temporary) approach. In person examination (and review of your prior surgery) is really necessary to best determine the cause of the notching and how to address it.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Thanks for your questions. A columellar scar which is done poorly can be very difficult to correct. A stair-step incision is not often ideal compared to an inverted-V. Excising the scar is one option with a meticulous closure using delicate sutures. I use 6-0 and 7-0 suture which are very tiny but work well for approximating the skin. Cartilage grafts underneath can be used to provide support if there is a volume deficit. Sometimes, nanofat injected at the scar line can provide stem cells and growth factors ideal for healing. It is difficult to say that the scar would be completely unnoticeable if many efforts have already been tried, though improvements could likely be made. I hope you find this helpful!

Notched columella after revision rhino. What can be done to correct this? (Photo)

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