Visible scars from percutaneous osteotomies

One of the criticisms of the percutaneous lateral nasal osteotomy technique is the potential for unfavorable, visible scarring. No clinical study has compared the external percutaneous approach with an internal approach to evaluate scarring in the same patient. This prospective, randomized, blinded study was designed to test the hypothesis that percutaneous perforating osteotomies cause perceptible scars when compared with the transnasal internal lateral osteotomy methods.

Fifty consecutive rhinoplasty patients requiring bilateral osteotomies (100 total lateral osteotomies) were prospectively randomized (institutional review board no. 1341-1M) so that each patient received an external skin puncture perforating osteotomy on one side and an internal lateral osteotomy on the control side. The percutaneous skin puncture was made with the flat edge of the sharpened 2-mm unguarded osteotome. The puncture site was approximated with Steri-Strips as part of the postoperative nasal splint. All patients were evaluated for scarring on the left versus the right side of the face at 1, 3, and 6 weeks; 6 months; 1 year; and when possible up to 2 years after the operation. The median follow-up in this series is over 1 year.

The external percutaneous approach caused a visible scar in three patients (6 percent) as noted by three blinded examiners. One of these patients (2 percent) required a scar revision. Care must be taken to cleanse the chisel before percutaneous entry. This practice should avoid a traumatic tattoo.

Percutaneous osteotomies generally produce an imperceptible scar (94 percent) but may cause a visible scar in a small percentage of patients.