Columellar Incision Research Articles

Implementation of delayed intervention in open approach rhinoplasty for patients with supratip scarring

The columellar incision and dissection which were integral steps in open rhinoplasty play a crucial role in achieving optimal results. However, scarring in the supratip region may pose challenges to skin circulation, potentially leading to complications such as flap loss. This study aims to establish the safety and efficacy of the open rhinoplasty technique as a viable alternative for patients with substantial scars in the supratip region typically addressed using the closed rhinoplasty technique. Patients with scars on the tip or supratip region were operated clinic between February 2010 and March 2023. To mitigate the risk of tip necrosis, a meticulous two-step delay approach was employed. In the initial outpatient procedure, performed under local anesthesia, we opted for a columellar incision. Subsequently, the columellar arteries were identified and cauterized to facilitate the delay procedure. Following a ten-day interval, all patients underwent standard open rhinoplasty. The columellar artery delay procedure proved instrumental in executing successful open rhinoplasty without compromising skin circulation between the scarred supratip and columellar incision line. Our findings suggest that the columellar delay procedure effectively prevents flap loss in open rhinoplasty patients with scars in the supratip and columellar regions. This brief outpatient intervention, lasting approximately ten minutes, provides a reliable method for adopting the open approach in primary rhinoplasty cases, irrespective of prior scarring. Level IV, therapeutic study.

Columellar incision in labiocolumellar junction

Columellar incision in labiocolumellar junction

Skin Tensioning Concept in Rhinoplasty Using a Semifixed Support Mechanism.

As the skin on the nose shows outwardly, if we do not consider the volume of skin on the nose that is reduced, the results may be unsatisfactory. Although redraping the skin over a wide area may help, excess skin cannot be adequately controlled in some cases. During skin tensioning, a semifixed support mechanism was applied to keep the nasal tip stable and maintain its position while simultaneously allowing stretching and mobility in accordance with its normal function. The dorsal and infratip/columellar skin was stretched by using the support of the most projected part of the nasal tip. The skin was pulled posteriorly to obtain sufficient tensioning and excised at the columellar incision line. Of the 94 patients who underwent skin tensioning, 82 were women, and 12 were men. The ages of the patients ranged from 18 to 59 years. Ninety-one patients were primary rhinoplasty patients, and 3 patients were secondary rhinoplasty patients. Skin tensioning was performed in 31 patients with overprojection, 24 patients with thick skin, 17 patients with low skin elasticity, 12 patients with excessive skin elasticity, 7 patients with an advanced long nose, and 3 patients with scar tissue due to previous surgery. No serious complications, either functional or aesthetic, related to skin tensioning was encountered. The skin tensioning technique using a semifixed support mechanism helped to achieve a required reduction with a sufficiently defined appearance of the nose in patients with difficult skin.

Long-Term Results of the Murawski Unilateral Cleft Lip Repair.

In 1968, Ralph Millard published his "Millard II" method for repair of wide, complete unilateral cleft lip and nose deformity. In 1979, Murawski published a major modification of the Millard II procedure in Polish. This motif was taken up 8 years later by Mohler and 22 years later by Cutting. The Murawski variation on the Millard II procedure has become a dominant motif in unilateral cleft lip repair worldwide. This brief report intends to introduce the method to the English language literature and present long-term results. The Murawski method alters the Millard II procedure by changing the upper medial curve into a point in the columellar base. This creates a broad C flap used to fill the entire defect produced by downward rotation of the medial lip. Millard's lateral advancement flap becomes unnecessary. A lateral approach to primary nasal reconstruction allows the lateral C flap to be used to construct the nasal floor and sill. The method is described using a physics-based surgical simulator. Long-term results of the method are demonstrated with four patients with 15 to 25-year follow-up. None of these patients had any revisions to the lip or nose. The Murawski repair was the first to modify the Millard II repair by sharpening the medial columellar incision, eliminating the need for a lateral advancement flap. This motif was put forth in the years to follow by Mohler and Cutting. Long-term results of the method are presented.

Open Rhinoplasty for Nasal Tip Correction by the Transverse Columellar Incision for Egyptian & Mediterranean Noses

Rhinoplasty may be the most common, most challenging, most unforgiving in plastic surgery. It is an ultimate combination of an evolving art and science. Rhinoplasty is a precise surgery in which the margin of error is measured in millimeters. Excellent results can only be obtained by a thorough knowledge of nasal anatomy and the surgical relevance of the alteration of the anatomic structures. To a lot of the Junior Staff, Rhinoplasty is a blind procedure requiring much imagination. This procedure has always been a challenge to the plastic surgeons. Objectives: Since the early eighties I had all the worry a young plastic surgeon has: standardizing his results for Aesthetic Rhinoplasty. Results were not always what one expected, and definitely tip correction was a great challenge. It was then I embarked adopting the open Columellar Incision. I am sharing with you my journey over 40 years and the results of believing and mastering a technique, preaching it in different arenas, and the final results achieved d not only nationally or regionally but also internationally when this technique is now universally accepted as a precise tool for better refinement. The indications limitations and the ghost of the scar are shown and proved to be over stated. In the millennium different strategies (suturing and grafting) have been adopted to obtain better aesthetic outcome and less functional disturbances, all these seem to go hand in had with the open rhinoplasty incision. Different indications are briefly gone through in this review and the long-lasting results are shown. Conclusions: Excellent symmetry, Lack of supratip deformity, particularly in Secondary and Tertiary Rhinoplasty The scar was inconspicuous in the healing phase, then in a few months it tended to migrate lower down and becomes almost invisible. The use of either grafts or various tip sutures can help in the control of the tip dynamics. The aesthetic outcome following a combination of suturing and grafting was more satisfactory than the outcome that can be achieved following either one of them. All these techniques could not be achieved through a closed endonasal rhinoplasty

Columellar Scar Following Open Rhinoplasty Using Absorbable Suture Versus Nonabsorbable Suture: A Meta-Analysis.

Objective: This meta-analysis seeks to determine whether a difference in long-term scar outcomes exists between absorbable and nonabsorbable sutures for closure of the columellar incision after open rhinoplasty. Review Methods: PubMed, OVID Medline, Conference Papers Index, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched using terms including "suture," "sutures," "absorbable," "columella," "columellar," "transcolumellar," "trans-columellar," "rhinoplasty," "septorhinoplasty," "scar," "scars," and "scarring," as well as associated MeSH terms. Results: Six studies with 435 patients were included for systematic review and meta-analysis, with five studies included in meta-analysis for patient-reported outcomes, and six studies included for physician-reported outcomes. There was no significant difference in scar appearance between the absorbable suture group and nonabsorbable group among both patient-reported and physician-reported outcomes. Conclusion: This meta-analysis of six studies meeting inclusion criteria does not demonstrate a significant difference in long-term scar appearance based on suture type after open rhinoplasty.

Patient and Observer Graded Rhinoplasty Scar Outcomes: A Randomized Controlled Trial of Fast Absorbing Versus Permanent Columellar Suture Closure.

Background: When performing an open rhinoplasty, surgeons commonly use nonabsorbable skin sutures to close the columellar incision. These are believed to minimize scarring. However, removal can be associated with patient discomfort and outcomes may not be superior to using absorbable sutures. Objective: To compare difference in scar appearance for columellar closure after rhinoplasty with absorbable and nonabsorbable sutures. Methods: We performed a prospective randomized control trial with 61 patients. Forty-one patients completed follow-up and were included in final analysis: 23 whose columellar incision was closed with absorbable sutures and 18 with nonabsorbable sutures. A blinded surgeon performed Stony Brook Evaluation Scale (SBES) and a patient performed Patient Scar Assessment Questionnaire (PSAQ) was completed for each suture type. Results: Our results did not reject the null hypothesis that there is no difference in SBES or PSAQ scores between absorbable and nonabsorbable suture types. Conclusions: No difference was detected in scar outcomes between absorbable and nonabsorbable sutures for closure of the columellar incision created during an open rhinoplasty as rated by both patients and blinded clinicians.

Absorbable Versus Non-Absorbable Sutures in Open Rhinoplasty: Analysis of Columellar Scarring.

Open rhinoplasty involving columellar incision has gained popularity since the 1930s. Many surgical incision techniques have been employed to obtain better results in terms of postoperative scarring. This study evaluated and compared the results of absorbable and non-absorbable sutures used in open technique rhinoplasty, assessed scar properties regardless of the techniques used, from the perspectives of patients and surgeons. This study evaluated and compared the results of absorbable and nonabsorbable sutures used in open technique rhinoplasty from the perspectives of patients and surgeons. Study population included 70 patients who underwent primary open rhinoplasty between 2013 and 2018. Rhinoplasty Operations were performed in 2 different centers by a total of 2 rhinoplasty surgeons. Both surgeons used suture materials, which can be used for columellar closure, regardless of patients' skin characteristics. Columellar scars were assessed at an outpatient clinic at least 6 months postoperatively. Patients who could not come to the clinic were excluded from the study. Columellar Scars were assessed using the Turkish Patient Observer Scar Assessment Questionnaire. Patients were also asked to complete a Scar Assessment Analysis Questionnaire at the outpatient clinic, and were photographed from the front, basal, and right and left oblique sides. Three surgeons, who were not part of the research team but routinely performed rhinoplasty, completed the Observer Scar Assessment Questionnaire by examining patients in person at the clinic as well as their photographs. Observer Scar Assessment Questionnaire results; for the Vicryl group, surgeons ranked pigmentation of the scar as the best criterion (3.34 ± 0.97) and irregularity of the scar as the worst (3.82 ± 1.01). For the Prolene group, surgeons ranked irregularity as the best criterion (3.30 ± 0.97) and stiffness as the worst (3.54 ± 0.94). Although there was no statistically significant result between the two groups in the criteria, the mean scores of the Prolene group were less than the Vicryl group. (3.36 ± 0.46, 3.50 ± 0.65 respectively).Scar Assessment Analysis Questionnaire Results; patients in both the Vicryl and Prolene groups ranked pain as the least important factor (mean 2.9 ± 1.11 and 3.33 ± 1.35, respectively). The Prolene group scored lower than the Vcryl group in terms of overall scarring (3.49 ± 0.72, 3.66 ± 1.37, respectively, P > 0,05). Absorbable sutures are a convenient alternative to nonabsorbable sutures. Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Evaluation of the effectiveness of the use of free diced cartilage in dorsal and tip nasal rhinoplasty

BackgroundRhinoplasty is considered one of the most challenging operations in the plastic surgery. Esthetic or functional reshaping purposes of the nose can be stressing for both surgeon and patient. Different types of graft materials have been used to perform augmentation rhinoplasty. Free diced cartilage (FDC) was recently established in dorsal nasal rhinoplasty for better handling of irregularities as well as contour deficits of dorsal nasal outcomes. The main purpose of the present study is to assess the effectiveness of the use of FDC in dorsal nasal and nasal tip rhinoplasty and evaluation of its advantages and disadvantages using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale and the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess nasal obstruction and patient satisfaction.ResultsThis prospective study was conducted between March 2018 and December 2019, 20 patients were included and planned for rhinoplasty using FDC to camouflage dorsal and nasal tip deformities. All patients (11males and 9 females) underwent open rhinoplasty through inverted v columellar incision, taken FDC from nasal septum. A statistical significant difference between pre- and post-operative NOSE scores was found (P < 0.001). Post-operative rhinoplasty outcome evaluation scores ranged from 45 to 100 with mean ± SD (83.15 ± 13.22). Excellent satisfaction was the most noted in 17 patients (85%), while 2 patients (10%) reported good satisfaction and 1 patient (5%) with acceptable satisfaction.ConclusionIt was found that the FDC technique is an effective method for camouflage and augmentation of nasal dorsum as well as nasal tip in reconstructive and esthetic rhinosurgery for either primary or secondary rhinoplasty.

Comparison of Rapid Absorbable Sutures with Nonabsorbable Sutures in Closing Transcolumellar Incision in Septorhinoplasty: Short-term Outcomes.

Following open rhinoplasty, a postoperative scar at the columellar incision line is a common morbidity. The aim of this study is to compare absorbable and nonabsorbable suture materials which had been used for closing the transcolumellar incision, in the aspect of risk of postoperative infection, wound healing, postoperative columellar scar and patient satisfaction. A prospective, randomized, single-blind study was conducted between May 2017 and February 2018. Sixty-four rhinoplasty patients were randomly assigned to absorbable (n = 32) or nonabsorbable (n = 32) groups. The columellar incision was closed with 7 full-thickness skin sutures. Either nonabsorbable 6/0 polypropylene (Group 1) or absorbable 6/0 polyglytone 6211 (Group 2) sutures were placed at the columellar incisions. Polypropylene sutures were removed at the 7th postoperative day. A Mann-Whitney U test and Monte Carlo were used for statistical comparison. Photographs of the patients at the postoperative third month (Fig.2) were evaluated and scored in terms of scarring, pigmentation, notching, level differences in the incision area by two different otorhinolaryngologists who did not know the randomization. Suture removing discomfort was assessed with visual analogue scale scores. A satisfaction survey was filled out by all the patients completing their third month after the operation. According to the results of both otorhinolaryngologists, there was no significant difference between the two groups in terms of pigmentation, level difference, notching, overall appearance and total score (p = 0.920, p = 0.498, respectively). The mean score on the Wong-Baker scale was 3.19 ± 1.67 in group 1. In the Satisfaction Survey, the average score of the group 1 was 6.90 ± 3.24, while the mean score of the group 2 was 7.062 ± 2.77. There was no statistically significant difference between the two groups (p = 0.715). Suturing inverted V transcolumellar incisions with rapid resorbable sutures caused significantly less discomfort but no difference in scarring compared to nonresorbable sutures as evaluated by patients and observers. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Microsurgical Approach in Primary Cleft Rhinoplasty—An Anthropometric Analysis

Oral and maxillofacial surgeons use different approaches to repair the nasal deformity of patients with a cleft lip deformity, differing in technique and timing. The aim of this longitudinal study was to analyze a new surgical technique to treat the cleft nasal deformity at 4 to 6weeks of life using a microscope. Twenty-seven newborn patients with a cleft lip deformity were treated by primary repair of the nasal deformity using a microscope at 4 to 6weeks of life. The procedure includes a columellar incision, alar cartilage plication sutures according to Daniel (Plast Reconstr Surg 103:1491, 1999), and trans-columellar sutures. All patients were photographed at specific time points up to 1year after surgery. Established angles and distances were analyzed and compared with normal values of age-matched children by Farkas (Anthropometry of the Head and Face [ed 2]. New York: Lippincott Williams and Wilkins, 1994). All parameters improved through surgery and showed stable values at follow-up assessments. Almost ideal values concerning symmetry, as indicated by columellar deviation and nostril comparison, were obtained. Measurements of nasal morphology were similar to established norm values. The authors recommend the early treatment of cleft nasal deformity using microscopic surgery because it shows stable and symmetrical results at least up to 1year after surgery. Clinical observations up to adolescence suggest no growth disturbance or deterioration of nasal shape.

Outcomes of external septorhinoplasty in a Turkish male population.

IntroductionThe first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development.ObjectiveTo evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population.MethodsIn total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18–61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study.ResultsMean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted “V” incisions were performed in 15 (53.6%) patients while “V” incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty.ConclusionsThis study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Closure of nasal septal perforations with a polydioxanone plate and temporoparietal fascia in a closed approach.

Septal perforation closure is still often invasive and complex, with relatively low closure rates. We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches. The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks. Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach. We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

Comparative Columellar Scar Analysis Between W Incisions and Inverted-V Incision in Open Technique Nasal Surgery.

A visible scar on the columella is undesirable result for both patient and surgeon. So it is one of the major disadvantage of open nose surgery. Different columellar incision types have been used in open technique of nasal surgery. In this prospective study, we compare W incisions and inverted-V columellar incisions with a scar assessment scale. In this prospective randomized study, open nasal surgery (open rhinoplasty and open technique septoplasty) were performed on 93 patients between November 2009 and July 2012. The inverted-V incision was used on 31 patients (24 males, 7 females). The "W" incision was used on 62 patients (40 males, 22 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6-0 interrupted polypropylene sutures. All sutures were removed on the seventh postoperative day. Scars were assessed at 6 moths, with 3 items scar assessment scale, we observed satisfactory scar, pigmentation, and notching. We compared both groups and found that the scar pigmentation, notching and scar formation are similar to each other. As a result of this study we concluded that the inverted-V incision or "W" incision might be a similar choice in open nasal surgery.

Intraoperative use of a tablet computer to aid rhinoplasty.

Open septorhinoplasty enables excellent exposure to the structural components of the nasal tip. Nevertheless, it runs the risk of weakening its support mechanisms, which can lead to notable changes to tip projection and rotation as well as to the nasolabial angle. It is therefore paramount that the surgeon reconstructs the nose to the desired endpoint at the end of the operation. Currently, the gold standard of care in rhinoplasty uses preoperative photographs with the patient sitting or standing. However, this is not a true representation of the face in the operative position as the patient is placed supine and so gravity affects the appearance of the nose in a different way. Other factors such as head drapes and traction on the endotracheal tube can also cause subtle changes. We therefore advocate additional intraoperative profile view photographs to improve the accuracy of nasal tip positioning. In our department, in addition to standard preoperative photographs, immediate preoperative profile photos are taken with the patient supine, intubated and draped. Images are captured using a tablet computer at a distance of 1meter from the patient. We ensure that the Frankfort plane is perpendicular to the floor. The picture is enlarged so that the image is full scale and the tablet is subsequently placed immediately behind the patient for direct comparison. This is then used during the procedure to check tip projection and rotation as well as at the end of the procedure following closure of the columellar incision to ensure correct placement of the nasal tip.

Columellar Incision Scars in Asian Patients Undergoing Open Rhinoplasty.

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. To evaluate the incidence and evolution of and risk factors for columellar incision scars in an Asian population. 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. 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. 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). 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. 4.

Isolated Congenital Nasal Bifid Septum Separated by a Wide Layer of Soft Tissue.

Isolated Congenital Nasal Bifid Septum Separated by a Wide Layer of Soft Tissue.

Anatomical Study of the Medial Crura and the Effect on Nasal Tip Projection in Open Rhinoplasty

Common variations in morphology of the medial crura have been described. The authors' observation is that changes in nasal tip projection depend on the shape and strength of the medial crura. The authors investigated how differences in medial crura shape affect tip projection after surgical intervention. Seventeen cadaver heads were dissected with an open rhinoplasty approach. Nasal tip projection and columellar length and width were measured. Medial crura shape was noted and classified. Anthropometric measurements were made preoperatively and after each of the following procedures: (1) elevation of skin envelope and closure of the columellar incision, (2) interdomal and medial crural sutures, and (3) placement and fixation of a floating columellar strut. Three anatomical variations of the medial crura were noted: type 1, asymmetric parallel (n = 7); type 2, flared symmetric (n = 5); and type 3, straight symmetric (n = 5). A significant difference in tip projection after elevation of the skin envelope and closure was discovered between types 1 and 3 (p = 0.004). Type 2 medial crura were found to have a mean reduction of 1.0 mm. Suture techniques resulted in return to baseline tip projection for types 1 and 2. Columellar strut placement increased tip projection in all types. Changes in tip projection after an open rhinoplasty depend on the shape of the medial crura. Straight symmetric (type 3) cartilages can maintain tip projection without any additional intervention during an open rhinoplasty. Asymmetric parallel (type 1) or flared symmetric (type 2) variants will require interdomal and medial crural sutures to maintain baseline tip projection.

Effect of Nose Skin on the Columellar Incision Scar in a Turkish Population

To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results. Prospective, clinical study. Otorhinolaryngology department of a tertiary hospital. The preoperative dermal thickness of 50 consecutive patients undergoing "external approach" septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores. There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P > .05). However, men healed significantly better than women (P < .05). The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing.

Alar-Spanning Suture for Tip Contouring in Closed Approach Rhinoplasty for African-Caucasian Noses

The alar-spanning suture is one of the easiest techniques for correcting the width of the alar complex that reduces the bulbous tip of African-Caucasian patients. This conservative technique does not weaken the lateral crura and yields long- term predictable results. Rhinoplastic surgeons should keep in mind this useful and reliable tool in their options for refinement of these challenging wide tips and not create so dramatic a change that the appearance is not consonant with the patient's ethnic heritage. Despite cosmetic surgeons usually performing it through an external columellar incision approach, it is possible, in many cases, to do it in a closed access, and thus avoid the risk of hyperpigmentation or hypertrophic scarring.