Prominent Indented Columella Scar. What Are my Treatment Options? (photo)

Thank you for the great question and the pictures.  As some others have said, the issue with revising this type of scar is that you can't get rid of any tissue without affecting the shape or projection of the tip of the nose. While it is true that the incision can be made again, without cutting away the depressed scar, the improvement would likely be minimal at best. It would be possible to remove some of the anterior-most part of the septum to provide laxity, which would then allow the scar to be trimmed, but would also change the tip shape somewhat. A final option that I have used in my revision rhinoplasty practice is laser resurfacing. Using low settings (because of the sensitive nature of the skin here), some improvement in texture and surface smoothness can be achieved.
 

     The scar can be revised under local anesthesia with closer approximation of the respective tissues.  Kenneth Hughes, MD Los Angeles, CA

A simple scar revision (cutting out the scar and sewing the skin edges back together) done using a local anesthetic in the office should fix this issue.

 One camouflage solution would be to trim back the membranous and  cartilaginous septum to reduce the columellar show, and thereby making this columella not quite so prominent and helping hide this scar

The most likely reason for your inverted columellar scar is that there was not appropriate eversion of the skin edges during closure. Correction with surgery is certainly possible but it will not be successful if the scar is just cut out and brought together again. Such a move would only create a loss of tip projection and probably a worsening of the scar. If surgery is chosen then things should be opened up and some type of increased support and increased width to the columella accomplished with a strut. Both sides of the incision will need to be mobilized before re approximating them and the tip skin should be undermined widely to allow it to close without tension.

There is a possibility that placing some filler in the scar will help to elevate it and there is nothing to lose by trying some Juvederm or Restylane.

Unfortunately, this is one of the consequences of an "Open Rhinoplasty".  For this reason, I prefer a closed approach (no scar on the columella).  Nevertheless, you will see the same scar in the majority of patients with an open approach, if you are looking.   Simple scar revision can shorten the columella and make the issue more noticeable.  I would consider micro fat grafting to the area.  Fat grafting has been shown to improve the quality of the overlying skin, as well as filling depressions.  It is very important that you consult a board-certified Plastic Surgeon, who specializes in Rhinoplasty, before embarking on any procedures.

 

I agree that a simple excision of the scar with closure would be the best choice. This most likely could be done under local or sedation if you are very sensitive.