Englewood Rhinoplasty doctors

The indented area at the the base of the columella where it meets the nasal sil (nostril base) is most likely a 'relative' depression.  In other words, the columellar skin was dissected and remains significantly swollen at 1 month following rhinoplasty.  The nasal sil region was not dissected and did not suffer nearly the same degree of swelling.  Hence the columellar skin stands out further than the nostril base.  In time the contour should significantly improve.  If they are not still to your liking then a minor revision procedure will be necessary.

Mario Imola, MD, DDS, FRCSC.

There are several techniques available to refine the nasal tip.  In general, they are aimed at decreasing the overall volume and width of the tip.  Depending on the specific underlying problem, one or more of the following may be indicated:

Nasal Tip Refinement:

• Cephalic Strip cartilage removal.
• Tip Suture Techniques  which can be either intradomal (limited to one side) or interdomal (cross the midline and modify both sides of the tip).
• Cartialge Tip Grafts.
• Defatting can be performed to thin the soft tissue envelope.

Unfortunately, the issue you describe relates to increased width of the nostrils upon animation (smiling).  This is related to the facial muscles pulling the nostrils sideways.  There is not a widely accepted procedure to address this problem.  Conceivably, one could consider interupting the facial muscle attachements to the skin along the side of the nostrils.  In order to be effective my guess is that such a manouever would adversely affect your smile which in my mind is not a good trade-off.  My advice would be: if you like your nose at rest, then leave well enough alone. 

Mario J. Imola, MD, DDS, FRCSC.

Sorry things may not have turned out as you hoped.  Unfortunately, at this point in time, the implant will not return back to the midline.  It the result is unacceptable to you, a revision surgery will most likely be necessary and it would be best to wait approximately 9-12 months before proceeding with that surgery. 

Silastic or any other type of synthetic nasal implants carry significant rsks that need to be considered before surgery:

• Chronic inflammation or recurrent infection.  The reason underlying this problem is the relative close proximity of the implant to both the outer skin surface and the internal mucosal surface of the nose. 
• Implant shift or migration.  Silastic (rubberized silicone) is particularly notorious for this because of its smooth smooth surface which leads to a capsule .  Porous polyethylene implants (Medpore) has a porous surface and tissue ingrowth into these small holes help to stabilize the implant.  Also, implant shifting can be minimized by securing the implant with either screws or suture techniques.
• Extrusion.  Implants can spontaneously break through the external skin surface or the internal nasal lining. 
• Bone resorption. Varying degrees of bone loss can occure under nasal implants, particularly if they are in place for long periods of time. 

As a result of these complications, the rate of synthetic implant removal ranges from 15 to 20 %.  This is a number based on my personal experience and extensive reviews of the literature.  My first choice when performing  nasal augmentation is to use the patient's own tissue, either ear or rib grafts.  If they insist on a synthetic implant then i would recommend using porous polyethylene (Medpore).  

Sincerely, M. J. Imola, MD, DDS, FRCSC.