title: The open approach in secondary rhinoplasty: choosing an incision regardless of prior placement.
abstract: BACKGROUND
  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 to the nose, and often the desire to reposition the transcolumellar scar, the senior surgeon (R.J.R.) has ignored prior incisions in the columella and has chosen to place the incision in the best location for the current operative plan.
  
  
  METHODS
  This article retrospectively reviewed 100 secondary rhinoplasty patients who had undergone two open procedures with different transcolumellar incisions performed by the senior surgeon from 2000 to 2010. Scar quality was graded preoperatively and postoperatively by three reviewers on a four-point scale from imperceptible to poor scar.
  
  
  RESULTS
  Scar quality averaged 1.68 preoperatively and 1.61 postoperatively, indicating scar quality between imperceptible and barely perceptible. There was no skin bridge necrosis in the series, no infection, and no wound breakdown. Patient satisfaction was noted to be high overall.
  
  
  CONCLUSIONS
  Anatomical studies have previously shown the safety of the transcolumellar incision in rhinoplasty. This article has shown the safety of ignoring prior incisions in the columella and basing the new scar location solely on where the surgeon feels is ideal. Although caution should always be used when creating possibly devitalized skin bridges, this study lends weight to the argument that one can safely ignore prior incision patterns in this aesthetically important and well-vascularized area.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Unger
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: David H
authors.initials: DH
authors.lastname: Cheng
authors.forename: Palmyra
authors.initials: P
authors.lastname: Geissler
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lee
authors.forename: Kailash
authors.initials: K
authors.lastname: Narasimhan
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009666:Nose / Q000098:blood supply / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods*