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Columellar incision in labiocolumellar junction

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Majority of primary and secondary rhinoplasties are presently done by open approach. Bad scar on the columella might spoil the general impression after an otherwise excellent rhinoplasty. Several types of incision and division of columella are popular, all placed in the central segment of the columella. The aim of this article was to convey experience with columellar incision in the labiocolumellar junction, which, in the author’s opinion, results in better cosmesis and in an intact columella.

Methods

The review of 483 rhinoplasties performed during the 4 years 2018–2021 was undertaken. Labiocolumellar incision through the border of the two distinct aesthetic units, the columella and the upper lip, was chosen for all 140 patients operated by the open approach. Scars were evaluated with respect to visibility, color match, and alinement to the surface of the surrounding skin and were graded into three categories: excellent, good, and poor. Skin and carnation types, depending on the amount of melanin pigment in the skin, according to Fitzpatrick, were determined for all patients. The correlation of the columellar scar quality and the skin type of the patient was examined.

Results

Columellar scars could be evaluated in 94 patients who were seen ≥ 1 year after operation. The scar was excellent or practically invisible in 55 patients (59%) and good or barely perceptible in 28 (30%). Poor or visible scars were seen in 11 patients (11%). Most of them were previously operated one or several times. Excellent and good scars were significantly more common than visible and bad scars (p < .001). The quality of the scar in the labiocolumellar junction did not depend on, whether patients had the lighter or darker skin. Both surgeon and the patients were satisfied, or very satisfied with the aesthetic outcome of the scar at the border of columella. The complications were transient and uncommon.

Conclusions

Advantage of the incision in the labiocolumellar junction was full exposure of the columellar anatomic structures and better control and planning of the desired shape of columella. Junction incision results in less conspicuous scar than incisions on the central segment of columella.

Level of Evidence

Level V, Therapeutic; Risk/Prognostic, clinical study.

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Acknowledgements

The author thanks Olov Aronson PhD, Kvantila Co., and Department of Sociology at Örebro University for determining the statistical significance of the findings and advice on the meta-analysis of the literature.

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The author received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Lidingö-Clinic, Stockholm-Lidingö, Kräftvägen 9, 181 29, Lidingö, Sweden

    Igor Niechajev

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  1. Igor Niechajev
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Correspondence to Igor Niechajev.

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Ethical approval

The study followed the ethical standards in conformity with the 1964 Helsinki Declaration and its later amendments. This is a retrospective study for which no ethical approval is required.

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Informed consent was obtained from all patients included in the study. Additional consent was obtained from patients shown in figures where they could be recognized.

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Igor Niechajev declares no competing interests.

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Niechajev, I. Columellar incision in labiocolumellar junction. Eur J Plast Surg 46, 999–1010 (2023). https://doi.org/10.1007/s00238-023-02130-9

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  • DOI: https://doi.org/10.1007/s00238-023-02130-9

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