I had minor rhynoplasty in Melbourne as a result I now have a hanging columell and alar retration on the right notril - can this be fixed with revision rhynoplasty? Also I had a deviated septum which the surgeon fixed (well tried to, as I still have breathing issues).
In Need of Revison Rhinoplasty
Doctor Answers (5)
It is important to know when your rhinoplasty was initially performed since your nose will continue to change during the first year after surgery. A revision rhinoplasty can certainly address the issues you have mentioned but photographs would be helpful to analyze the aesthetics of your nose. A hanging columella can be due to a long caudal (lower end) septum and/or alar (nostril) retraction so photos would be helpful in assessing your individual situation. Lastly, breathing will continue to improve after your rhinoplasty as the swelling inside your nose decreases so do not be too quick to judge your past surgeon until you are completely healed.
Treating hanging columella, retracted ala and nasal obstruction
The issues that you're notincing after your original rhinoplasty can usually be address wtih revision surgery. Without examining your nose it is hard to be too specific.
To improve the excess columellar show the columella can be reset in to improve its hanging. Bringing the retracted ala downward will also help with this. The method to treat retracted ala depends on the cause but possible techniques include alar rim grafts or lower lateral cartilage repositioning.
Your functional breathing problems can also be address. This may involve a revision septoplasty and/or improving any internal or external valve narrowing.
In need of revision rhinoplasty
The revision rhinoplasty procedure is always harder than a primary rhinoplasty. A hanging columella is best addressed by trimming back both cartilage and membrane in the columella to tuck the columella inwards. Alar retraction is treated with a composite skin and cartilage graft from the ear grafted to the inside of the nostril to bring the alar rim down. Any nasal obstruction can be addressed with further surgery on either a residual deviated septum or spreader grafts for valve collapse or the turbinate surgery if the inferior turbinates are enlarged. This can all be addressed in one operation, usually through a closed rhinoplasty.
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Correction of hanging columella, alar retraction, and breathing problems is possible with revision rhinoplasty
I'm sorry to hear that your results from your rhinoplasty were not satisfactory.
Revision rhinoplasty can certainly address the issues you have listed. It is hard to tell exactly what would be required without pictures, or a physical examination, but below are general techniques used to correct the problems you have.
The hanging columella is often the result of either poor columellar support, or a large columellar strut graft. Use of the tongue-in-groove technique with or without caudal septal extension graft can correct this issue. Often the appearance of the hanging columella is worsened by alar retraction. In general, rim grafts, or lateral crural strut grafts can help to correct the position of tha ala. These techniques require cartlage that may still be available in your septum, however harvesting from other areas such as ear or rib may be necessary.
The breathing issue is sometimes related to a residual septal deviation or turbinate hypertrophy, but often can be nasal valve collapse resulting from reduction of the dorsum (bridge). This area generally requires spreader grafts to help support the strength of the sidewalls during breathing. Spreader grafts can greatly improve breathing issues resulting from rhinoplasty, and also help to correct irregularites of the nasal sidewall that can be seen from frontal views.
Search for an experienced revision rhinoplasty surgeon in your area to discuss wheather these procedures would help you in your aesthetic and functional nasal goals.