Solutions for Drooping Columella After Rhinoplasty?

Question

I had my first nose surgery April 2008 for a big bulbous tip. He broke the bone to narrow my nose and narrowed my nostrils. I had a second open rhinoplasty in August 2009 to make the tip smaller.

	3 Weeks after surgery, a box fell on my nose and it swelled up even more. My nose is much wider, the tip is still big and now the columella hangs (which never did before). When I excercise or it's hot outside, my nose swells up, and it's uncomfortable. I've had 2 cortisone injections and don't know what else to do.

Toby Mayer, MD · Answer

We say it takes 6-12 months for the last small bit of swelling to go away. It has been 8 months and the nose will probably change very little. The hanging columella will not go away and you will need to have it repaired. You should see a revision rhinoplasty specialist who deals with these problems. I would not get any more cortisone shots in the nose.

William Portuese, MD · Answer

Cortisone injections will not help a hanging or droop in columella. A hanging columella is a relatively easy procedure, whereby a small amount of skin and cartilage in the columella can be removed to stop the columellar show that is occurring on the nose. The rest of the swelling will take some time in the tip after a revision rhinoplasty to settle down, and full healing will take approximately a year. The columella plasty can be performed as a touch-up procedure by the original surgeon or a standalone procedure under either a local or general anesthesia.

Jason Litner, MD · Answer

It's not abnormal to have some fluctuating swelling after a revision even many months after surgery. The injury you describe may have created some further or prolonged healing issues for you. But, at 9 months that should be at least starting to diminish by now.
In your photo, the area above your tip does look wide and the cartilage of the central tip can be seen very well through your skin which suggests you may have had a tip graft. It may be that your skin has been thinned resulting in the discoloration and the exaggerated appearance of the cartilage you mentioned. The splaying of the cartilage that makes up your nasal sidewalls may be caused by injury or surgery. So, poor cartilage support or graft issues may be responsible for your concerns.
It is impossible to say anything for certain without a thorough examination of your nose. If you are unhappy with your healing to date, I would suggest talking to your surgeon as a first step. He or she knows the details of what was done and can advise you more easily.
At the end of the day, your concerns should be improving by 9 months, not worsening, especially after repeated steroid injections. Multiple steroid injections can exacerbate thinning and discoloration of the skin, so I'd advise you don't continue down that path if you are uncomfortable with what your surgeon is telling you. Consider a consultation with a revision specialist if you're not getting the answers you need.

Solutions for Drooping Columella After Rhinoplasty?

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Solutions for Drooping Columella After Rhinoplasty?

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