An open technique for rhinoplasty is the most common approach used today by most plastic surgeons. While this does create a mid-columellar scar, it usually heals in almost to completely undetectable skin scar when careful attention is paid to its closure. Many surgeons uses skin sutures in this area that require secondary removal. While this may only be four or five sutures, this nasal area is very tender at this early point after surgery and neither the patient or surgeon look forward to their extraction.
In the August 2016 issue of the Aesthetic Plastic Surgery journal, an article appeared entitled ‘Rapid Resorbable Sutures Are a Favourable Alternative to Non-resorbable Sutures in Closing Transcolumellar Incision in Rhinoplasty’. The purpose of this reported study was to determine if rapid resorbable sutures could replace non-resorbable sutures in nasal transcolumellar incisions. This was assessed by looking at 41 rhinoplasty patients using columellar inverted-V incisions comparing patient discomfort, scarring and the risk for postoperative infection. Interestingly many of the patients were of Middle Eastern descent. (65%)The first 21 patients were sutured with non-resorbable 5-0 Prolene and the subsequent 20 patients with a rapidly resorbable suture material, the 5-0 Vicryl Rapide.
The results of the study showed that trimming the knots of the Vicryl sutures was significantly less uncomfortable than the removal of the Prolene sutures. Almost 1/3 of the suture extraction patients found it to be very painful. Almost all patients (98 %) found their columellar scars as aesthetically acceptable. In addition, most of the patients considered their scars to be invisible. No postoperative infection occurred in any of the study patients. In conclusion, closing the columellar incision in rhinoplasty withs rapid resorbable sutures caused significantly less discomfort but a similar superb scar appearance to non-resorbable sutures.
This study confirms what I have practiced for more than a decade in open rhinoplasty surgery. I converted to 6-0 plain (an even faster resorbing suture that does not even require trimming of the knot) to close the transcolumellar incision long ago and have seen the same similar scar results. The only time I use removeable sutures now is when there is some tension of the columellar closure usually due to significant tip projection increase.
Dr. Barry Eppley
Indianapolis, Indiana