Choosing a clinic for columellar lowering surgery: considering revision rates

The place where you undergo columellar lowering surgery can be distinguished by whether the clinic discusses how often revisions occur and the possibility of revision before surgery. The revision rate for nasal surgery (rhinoplasty) is 8.8% (approximately 9 out of 100 people) with the closed-approach method, which involves incisions only inside the nostrils.[1]In other reviews presented in summaries, reports showed 10% (1 out of 10 people). The most common reasons for revision surgery were nasal obstruction and deviated nasal bridge.[2].

How often do revisions occur?

It depends on the study, but approximately 8.8%. In a study examining patients who underwent nasal surgery using the closed-approach method, which involves incisions only inside the nostrils, the revision rate was 8.8%, which was reported to be approximately the same as the open-approach method (involving external incisions).[1]。Additionally, a paper analyzing multiple studies together (meta-analysis) also introduced another report showing a 10% reoperation rate. The most common reason for reoperation was nasal congestion and deviation of the nasal bridge.[2]。In the same summary, a report was also introduced showing that people who had undergone nasal surgery previously had approximately 5 times higher susceptibility to infection (relative risk 5.01).[2].

Why does the nose tend to leave dissatisfaction?

Compared to other cosmetic surgeries, nasal surgery tends to leave dissatisfaction with vague concerns from the patient, which is said to drive up the reoperation rate.[3]。The position of the nasal columella greatly changes the impression of the profile. On the other hand, it is also a part that is difficult to convey in words. Specifically aligning what to change and by how much before surgery directly leads to satisfaction afterward.[3].

What should be discussed before surgery?

In textbooks, the pre-operative consultation is divided into four stages. First, the surgeon listens to what the patient wants to change, next examines the nose and face, then decides on the surgical method, and finally clarifies the limitations and risks of the surgery.[3]。With columellar lowering surgery, the angle of the space below the nose, whether to change the height of the nasal tip at the same time, and where to harvest cartilage from are all determined at this stage.[3].

What changes depending on how you choose the material?

A meta-analysis that combined several studies showed that the complication rate (difficulties occurring after surgery) when using autologous rib cartilage is 14% (about 14 per 100 people), which is somewhat high. However, it is noted that this may be influenced by the fact that it is more commonly used in difficult revision surgeries.[2]Artificial materials (synthetic implants) are said to have a lower rate of complications themselves. However, once a problem occurs, revision surgery becomes extremely difficult. For this reason, autologous rib cartilage is recommended as the first choice for both initial and revision surgeries.[2]The columella support is first choice using the straight cartilage that divides the middle of the nose (nasal septal cartilage); if this cannot be used, cartilage from the ear or rib is used.[3].

Open vs. closed approach

A prospective study comparing open and closed techniques reported that the open approach provided better visibility of the surgical field and allowed for more accurate corrections in line with the nose's structure.[4]On the other hand, there are also reports that the revision surgery rate for the closed approach did not differ significantly from the open approach.[1]In reality, whether the surgeon is more experienced with one method or the other matters more than which method is used. In the open approach, the columella is incised, so you should also ask about where and how that scar will be placed.[3].

What to confirm with your surgeon at the consultation

There are three things to confirm: the direction and extent of movement planned for the columella, where the cartilage will be harvested from, and how the surgeon will respond if the result doesn't match your expectations.[3]According to textbooks, the external shape of the nose should be evaluated from the front, side, and below, including the positional relationship between the alar (alae) and columella and the shape of the nostrils. Whether the surgeon can explain using photographs is one benchmark.[5]Whether the surgeon informs you in advance that revision may be necessary after surgery is also a reasonable factor to consider in making your decision.[1].