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Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible? (photo)

I had open rhinoplasty 25 d ago to refine the tip and small hump. now my nostrils are more uneven than pre-op, and columella is deformed and getting worse. My left nostril became distorted and everted. I had alar and spreader grafts and c. strut, due to thin skin i had crushed cartilage padding of the tip that is showing sunken spots. Surgeon offered immediate revision and possible removal of grafts or wait one year - as a rule. It may get worse with time. Is early revision contraindicated?

Doctor Answers (8)

Rhinoplasty revision

+1

The longer you can wait for the revision the better off you will be, the easier the surgery will be and the lower the risk of complication will be. When I was a resident I reoperated on a rhinoplasty patient early to add something to the first operation rather than to correct something. The amount of swelling/edema was so great once I was inside doing surgery that I still remember it decades later but from the outside you could not appreciate it. The best thing you could do now is get complete copies of your operative reports so future surgeons will a frame of reference to work from. Your before surgery photos show valve collapse so graft removal may not be a good option.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.


Los Angeles Plastic Surgeon

Revison Rhinoplasty

+1

Hi,

I think its ok to wait 3 to 4 months then re-evaluate your nose. The collumelar incision looks like a stair step type and looks uneven, this may or may not improve. The other areas of your nose can also be improved upon but you may want to give it some time.

Best,

Dr.S.

 

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
5.0 out of 5 stars 209 reviews

Columella issue

+1

Sorry to say but I see what you are talking about. Without being in the surgery and seeing you in person, I would say follow closely with yoru surgeon, and seek other opinions in the future once things have healed.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

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Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible?

+1

Sorry for your post operative issues and YES I see them on the posted photos. Very hard to advise via the internet. Best is to obtain IN PERSON second opinions. In some cases early revision is advised but most are a wait and see issue for at least 9 months. My guess is early revision but again I have not examined you in person. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Rhinoplasty early revision or not

+1

Hi there

Your question is interesting. In general it's better to wait a year before a revision, as others have said.  However, I wonder if your nasal bones are displaced along the bridge.  At 25 days, there might be enough mobility in them to reposition them as we would do in a closed nasal fracture reduction.  If there's any movement in them, it will be much easier to do this now than later when they're solid. It's hard from your picture to see if this is truly a problem, as your photo is not taken absolutely straight, but it looks to be a possibility.

I would recommend you ask your surgeon to have a close look at your bridge and nasal bone position, and if it is not symmetric then have it straightened up now.  The tip, as others have said, might be better to wait on until it's settled.

Good luck.

Howard Webster, MBBS, FRACS
Melbourne Plastic Surgeon
5.0 out of 5 stars 47 reviews

Crooked Columella and Tip Revision?

+1

You may indeed need to have your columella fixed. There is no way I would even consider this until you are 6-12 months out. I concur with my colleagues that the anatomy can be extremely difficult to deal with even 6-12 months out but the idea of waiting that long is to allow scars to mature and soften. This will make the next surgery easier. Easy is a relative term here because none of these are easy. The other important part here is that time may resolve the issue. We can all sit here and say we think it may need to be fixed but the reality is that nose surgery takes 6-12 months before you really know what result you will have. Make sure that you keep an open communication with your original surgeon. Then you will have to do some soul searching as to how you will proceed. Whatever you do, it is so important to have a board certified surgeon who is skilled in Rhinoplasty surgery do these operations. I would advise you to hang in there and see how things settle out.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

May need a revision but need to wait a bit longer

+1

From your photos it appears a revision may be necessary.  At this point there is too much post-operative inflammation and swelling to safely and accurately perform revision surgery. I recommend waiting 6 to 12 months.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Deformity after rhinoplasty

+1

The columella deformity will likely need to be fixed, but immediate revision is a risky proposition since the wound is still fresh. The tissues are so inflamed that the anatomy will be indistinct and there will be poor purchase for sutures.  The risks of complications are too high to warrant more surgery right now.  Your best  chance for a good outcome is to wait 4-6 months until everything is soft and all scars are fully mature.  You then have to decide if the risks of revision are worth the benefits.

 

In general, revision surgery is always more complex because of scarring.  Be sure your surgeon has a broad experience with revisions: the anatomy is different, blood supply is different, and healing is different. 

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 11 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.