The open approach in secondary rhinoplasty: choosing an incision regardless of prior placement.

BACKGROUND: Secondary open rhinoplasty is a complex topic with many hazards. Although there has been much discussion in the literature about what transcolumellar scar design creates the best aesthetic result, placement of the scar in a previously opened nose has not been widely discussed. In light of the outstanding blood supply to the nose, and often the desire to reposition the transcolumellar scar, the senior surgeon (R.J.R.) has ignored prior incisions in the columella and has chosen to place the incision in the best location for the current operative plan. METHODS: This article retrospectively reviewed 100 secondary rhinoplasty patients who had undergone two open procedures with different transcolumellar incisions performed by the senior surgeon from 2000 to 2010. Scar quality was graded preoperatively and postoperatively by three reviewers on a four-point scale from imperceptible to poor scar. RESULTS: Scar quality averaged 1.68 preoperatively and 1.61 postoperatively, indicating scar quality between imperceptible and barely perceptible. There was no skin bridge necrosis in the series, no infection, and no wound breakdown. Patient satisfaction was noted to be high overall. CONCLUSIONS: Anatomical studies have previously shown the safety of the transcolumellar incision in rhinoplasty. This article has shown the safety of ignoring prior incisions in the columella and basing the new scar location solely on where the surgeon feels is ideal. Although caution should always be used when creating possibly devitalized skin bridges, this study lends weight to the argument that one can safely ignore prior incision patterns in this aesthetically important and well-vascularized area. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.