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Original Investigation |

Columellar Incision Scars in Asian Patients Undergoing Open Rhinoplasty

Ho Chan Kim, MD1; Yong Ju Jang, MD, PhD2
[+] Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, National Medical Center, Seoul, Republic of Korea
2Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
JAMA Facial Plast Surg. 2016;18(3):188-193. doi:10.1001/jamafacial.2015.2178.
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Importance  An open approach has been adopted for rhinoplasty because of its wide and undistorted exposure. The formation of a columellar incision scar is the main drawback of this approach.

Objective  To evaluate the incidence and evolution of and risk factors for columellar incision scars in an Asian population.

Design, Setting, and Participants  A retrospective case series of 529 patients who underwent open rhinoplasty was performed in a tertiary care referral center in South Korea from January 1, 2011, to May 31, 2014. Problematic transcolumellar incision scars were categorized into wide and depressed, notching, and hyperpigmented wound types. Follow-up was complete on January 28, 2015, and data were assessed from July 1, 2014, to May 29, 2015.

Main Outcomes and Measures  The incidence of each problematic scar and the time course of erythema evolution were evaluated. Factors affecting the formation of a problematic scar were also evaluated.

Results  Of 529 patients (176 female and 353 male patients; mean age, 31 [range, 5-70] years), 234 patients with at least 6 months of follow-up underwent evaluation for a problematic scar. Fourteen of the 234 patients (6.0%) had problematic incision scarring (wide and depressed wound, 4 [1.7%]; notching wound, 3 [1.3%]; hyperpigmentation, 4 [1.7%]; marginal incision hypertrophic scar, 2 [0.8%]; and columellar skin necrosis, 1 [0.4%]). Of the 243 patients with regular follow-up who underwent evaluation for erythema evolution, erythematous wounds were found in almost all in the immediate postoperative period and had normalized by a mean (SD) of 66.7 (37.4) postoperative days. Use of costal cartilage as tip graft material was associated with a problematic incision scar (2 of 25 patients [8.0%] vs 6 of 180 patients with other graft material [3.3%]; P = .02).

Conclusions and Relevance  In this cohort of Asian patients, the incisions used for an open rhinoplasty approach had some problems. However, the low incidence of problematic scars indicates that open rhinoplasty should not be discouraged because of the incision scar.

Level of Evidence  4.

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Figure 1.
Problematic Columellar Incision Scars

Scars are classified using the definitions of Foda6 as wide and depressed, notching, or hyperpigmented wound.

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Figure 2.
Representative Erythematous Wounds

Two male patients had erythema on the columellar incision site before postoperative day 30. Erythema gradually decreased and normalized by 2 months after surgery. All photographs show the basal view.

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Figure 3.
Columellar Skin Necrosis

A female patient underwent revision open rhinoplasty after 2 rhinoplasty procedures with silicone implant, each followed by implant removal. Scar contracture was found preoperatively. Skin necrosis developed at postoperative day 7, and a revision operation was performed using a subnasal rotational flap. Until postoperative day 138, the columellar scar remained.

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