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

Abstract 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 .