Last week I operated on a 40 year old man referred by a very conscientious dermatologist who had been trying to explain why the patient had a draining spot on his nasal tip that never healed. The area repeatedly became inflamed, healed, and became inflamed again. Biopsies had all been normal.
There are only three reasons why a draining sinus will not heal—it is connected to some structure with liquid in it, like nasal cavity, which this wasn’t; it is cancerous, which this wasn’t; or it signifies a foreign body. I noticed that the man had an open rhinoplasty scar, and on operation, I found buried permanent sutures that I removed. The problem should now be solved.
I do not use permanent sutures in rhinoplasty, partly for this reason, but also because there are more anatomical ways to create normal structure: the natural, attractive nose doesn’t have sutures shaping it. This type of
complication may be uncommon, but the surgeons who believe in open rhinoplasty must educate their colleagues and patients about the potential complications that they may see. If I have one criticism of open rhinoplasty teaching, it is not primarily the scar or the techniques; it is that its advocates spend too much time selling the operation and not enough time treating it as a surgical procedure that, like all others (including the ones I perform), will have advantages and drawbacks. No one can inform the public better than the surgeons who do and teach open rhinoplasty. Surgery cannot be marketed; it must be taught.