This study aimed to evaluate columellar
scar problems after external
rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the
scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external
rhinoplasty were included in the study. All the patients underwent surgery using the external
rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar
scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear
scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the
scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the
scar was unsatisfactory in 7% of the cases. This was because of
scar widening with or without depression (5%),
hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS)
suture significantly decreased the incidence of
scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar
scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good
postoperative care.