Choosing a Clinic for Columellar Reduction Surgery: Evaluating Based on Revision Surgery Rates

The place where you undergo columellar reduction surgery can be distinguished by whether the clinic discusses how often revision surgeries occur and the possibility of needing one before the procedure. The revision surgery rate for rhinoplasty is 8.8% for closed techniques[1], and according to another compiled report cited, 10%, with nasal obstruction and deviated nasal dorsum being the top reasons[2].

How Often Do Revision Surgeries Occur?

In studies targeting closed-technique rhinoplasty, the revision surgery rate was reported at 8.8%, which was comparable to open techniques.[1]In a meta-analysis comparing graft materials, a separate report cited a 10% revision surgery rate, with nasal obstruction and deviated nasal dorsum identified as the most common reasons.[2]The same review also cited that having undergone previous nasal surgery was associated with a relative risk of infection of 5.01.[2].

Why Is Patient Dissatisfaction More Common After Nasal Surgery?

It is noted that nasal surgery tends to leave patients with subjective dissatisfaction more often than other cosmetic procedures, and this drives up the revision surgery rate.[3]While the position of the columella significantly changes the profile appearance, it is a feature that is difficult to convey in words. Specifically aligning expectations about where and how much to move structures before surgery directly translates to satisfaction afterward.[3].

What Should Be Discussed Before Surgery?

Textbooks divide the preoperative consultation into four stages: first, asking what the patient wants to change; second, examining the nose and face; third, deciding on the surgical technique; and finally, clearly defining the limitations and risks of surgery.[3]For columellar reduction surgery, the angle at the base of the nose, whether to change the tip height as well, and where to harvest cartilage are determined at this stage.[3].

What Changes Based on the Choice of Graft Material?

In a meta-analysis comparing graft materials, autologous rib cartilage showed a complication rate of 14%, which is relatively high, but this may reflect its frequent use in difficult revision cases.[2]While synthetic materials have lower complication rates themselves, once problems arise, revision surgery becomes extremely difficult, and autologous rib cartilage is recommended as the first choice for both primary and revision procedures.[2]For columellar support, a straight nasal septal cartilage is the first choice, with auricular or rib cartilage used when this is not available.[3].

Open or Closed Approach?

In a prospective study comparing open and closed techniques, the open approach offered better visualization of the surgical field and allowed for anatomically precise corrections.[4]On the other hand, some reports show that the revision surgery rate for the closed technique does not differ significantly from the open approach;[1]in practice, the surgeon's familiarity with one technique or the other matters more than the technique itself. With the open approach, an incision is made on the columella, so it is important to ask about where and how the scar will be placed.[3].

What to Confirm During the Examination

Three things to confirm are: in what direction and by how much the columella will be moved, where the cartilage will be harvested from, and how problems will be managed if the result is not as expected.[3]According to textbook standards for external nose evaluation, the relationship between the alae and columella, and even the shape of the nostrils, are assessed from anterior, lateral, and inferior views, and whether explanations can be provided using photographs is a useful benchmark.[5]Whether the surgeon informs you in advance that revision surgery may be needed after the procedure is also a valid factor in your decision-making.[1].