What can be done about my Rhinoplasty Columella Scar? (photos)

Question

What can be done about my columella scar? My plastic surgeon injected it with steriods several times, but it did nothing. Another plastic surgeon tried an office visit scar revision, but it really didn't change. I hate looking up because it looks as though i have a large blister at the base of my nose. My surgery was done in 2010, and the scar revision completed in 2011. My nose isn't symmetrical either :(.

Andrew P. Trussler, MD · Answer

The transcolumellar scar typically heals very well and this may represent a malpositioned graft or hypertrophic scar. This should be amenable to revision and or dermabrasion, though consultation and evaluation would be needed to determine the proper plan. The scar could be correctable in the office though the asymmetry of the nostril would need an operative revision.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Tanveer Janjua, MD · Answer

It is one of the hardest scars to treat. The only solution is meticulous revision of the scar with steroid injections starting 2 weeks after the surgery. You might need a cartilage graft in the upper half of the columella to match the bulge below. RegardsDr. Janjua

Christian L. Stallworth, MD · Answer

Saturn-I am sorry you have had such difficulty after your rhinoplasty.  It is difficult to completely comment on your nose with out truly examining your nose in person.  I have seen patients like yourself that have poor scars from multiple reasons.  This could be from excessive scar tissue, altered lymphatic drainage in the columella or even due to underlying cartilage.  From the photos you display, I suspect you may have a shield (tip) graft that may extend into the columella.  You also demonstrate weak support in the ala, especially in the soft tissue facets (triangle).  All of these factors are contributing to your asymmetry as well.  For these reasons, continuing to focus only on the scar may only be one part of a larger problem.My greatest recommendation would be to schedule an in-person consultation with a surgeon who performs a larger volume of rhinoplasty with experience in the revision nose.  You may then review photographs, their experience, your exam and devise a treatment plan that is tailored for you.Best wishes!

Jose Barrera, MD · Answer

Thank you for your question regarding the rhinoplasty columellar nose scar. It appears to have a trap door appearance which means that some of the lymphatic flow may be impeded. Lymphatic obstruction may be an issue with scars that have been revised. I would consider laser resurfacing with a deep CO2 laser.

Gregory Roche, DO · Answer

Use Silagen ointment and sheeting as well as retinol and bleacher, then evaluate for possible scar removal with C02, Fat, and PRP.

Jeffrey Watson, MD · Answer

Your choices are really dermabrasion or scar revision. I'm sorry this has been such a challenge. The key to figuring out how to fix yours is a good in person exam. You may need a tiny bit of bulk, such as crushed cartilage graft under the part that is not bulging as much so that the surfaces meet evenly.

Victor Chung, MD · Answer

Rhinoplasty is a surgery to improve the shape of the nose for breathing or appearance. The surgery may be performed with a closed or open approach. One of the telltale signs of the open approach is an obvious scar on the columella (bridge of skin between your nostrils). The best method to improve an obvious scar is to cut out the old scar and meticulously bring the edges back together. It is important to evert the edges, align the sides, and use a very small suture. I like to use 7-0 nylon suture in vertical mattresses. Patients who have excess tension on the nasal tip or a low/high scar (too close to the base or the tip) may not be candidates for this scar excision method of revision. I would discuss this with your surgeon to determine what options are appropriate for you to achieve a safe and happy result. Safety comes first.

Richard W. Fleming, MD (retired) · Answer

I'm sorry you have a scar after your previous procedures but this can be improved, usually under local anesthesia. with these pictures I cannot comment on your nasal asymmetry. Please post pictures as described on my website for nasal evaluation.