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

Unger JG, Roostaeian J, Cheng DH, Geissler P, Lee MR, Narasimhan K, Rohrich RJ.

What this paper says

In 100 revision patients whose columella was reopened through a new incision that ignored the old scar, scar quality stayed between imperceptible and barely perceptible (1.68 before, 1.61 after) with no skin death, infection or wound breakdown.

Overview

Open rhinoplasty leaves a small scar across the columella. When a previously opened nose needs revision, surgeons worry that cutting a new line near the old one could starve the skin between them of blood. The senior author (R.J.R.) has placed the new incision wherever the current plan needs it, and this review checks whether that was safe.

Sections of note

Retrospective review of 100 secondary rhinoplasty patients who had two open procedures with different transcolumellar incisions by the senior surgeon, 2000 to 2010.
Scar graded before and after by three reviewers on a four-point scale, from imperceptible to poor.
Mean scar score 1.68 preoperatively and 1.61 postoperatively.
No skin bridge necrosis, no infection, no wound breakdown.
Patient satisfaction noted as high overall; the abstract gives no satisfaction figures.
The authors still advise caution when creating possibly devitalized skin bridges; level of evidence IV.

What it means for a patient

A revision surgeon can place the columellar incision where it works best for the new operation, even if it differs from the first scar.
In this series the second scar was as inconspicuous as the first, with no wound complications.
One surgeon's cases; scar grading was by reviewers rather than patients, and smokers or other risk groups are not described.

Why this paper matters

It removes a practical constraint on revision open rhinoplasty and documents the columella's rich blood supply in clinical terms. The finding applies to a well-vascularized area and should not be generalized to other scars.

Terms

Transcolumellar incision: the small cut across the columella used in open rhinoplasty.
Columella: the strip of skin and cartilage between the nostrils.
Skin bridge: the strip of skin between two incisions, at risk if its blood supply is cut off.
Necrosis: death of tissue from loss of blood supply.
Secondary rhinoplasty: a repeat operation on a nose that has already had surgery.
Level IV evidence: a case series without a comparison group.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“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…”

Excerpt; the full abstract is on PubMed.