Comparison of Polydioxanone and Polypropylene Sutures in Columellar Incision Closure: A Prospective Randomized Clinical Trial

BACKGROUND: Columellar scarring remains an important aesthetic concern in open septorhinoplasty, and while multiple studies have compared absorbable and non-absorbable sutures, the specific effects of slowly absorbable polydioxanone (PDS) on long-term scar outcomes have not been previously investigated. MATERIALS AND METHODS: Ninety-six patients undergoing primary septorhinoplasty between January 2023 and January 2024 were randomly assigned to the PDS (n = 47) or Prolene (n = 49) groups. Patients with prior nasal surgery or systemic connective tissue disorders were excluded. Scar appearance was evaluated one year postoperatively using the Stony Brook Scar Evaluation Scale (SBSES) and a 0-100 visual analog scale (VAS) rated by both patients and a blinded otolaryngologist. RESULTS: There were no statistically significant differences in patient VAS scores (P = 0.326), physician VAS scores (P = 0.055), or SBSES scores (P = 0.41) between the groups. Confidence-interval-based non-inferiority analyses supported non-inferiority for physician-rated VAS, whereas patient-rated VAS and SB total were close to the prespecified margins. CONCLUSION: PDS sutures yield comparable aesthetic outcomes to Prolene and offer the additional benefits of absorbability and sustained tensile strength. They may be preferable in cases where long-term support is needed or where suture removal may cause discomfort. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .