Can hanging columella and crooked nose 3 months after revision rhinoplasty be caused just by swelling? (Photos)

Question

I am 3 months after the revision rhinoplasty and my nose looks CROOKED. It had never been crooked before,neither my natural nose nor after the primary rhinoplasty. I can move the skin on the top and straighten it, but after few seconds it’s crooked again. My second concern is HANGING COLUMELLA and bulbous tip. The hanging columella was the main reason why I did revision rhinoplasty and now it makes me look like a witch from certain angles when I smile. It took 18 months to get rid of swelling first time?

Alejandro Nogueira, MD · Answer

Your case is difficult to assess from an historical point of view, 2 different procedures spaced long time have taken place making thus very uncertain judgements about the quality of the work done before, mainly due to the very poor quality of the pics posted to depict the first rhinoplasty results.Also, a great care has to be taken considering the short period of only 3 months, when a revision rhinoplasty recovery period has barely began, since normally takes 10 to 18 or even 24 months to stabilitize.In spite of that I'll try to enlighten with some judicious comments:-the primary congenital nose was a not easy one, if any is; it was a very broad bridge case, with atypically high radix, this means a difficult dorsum management; also the tip was difficult, a bulbous, cleft, overpojected and poorly shaped one, with verticalization of the lateral cruras (aka "parenthesis tip deformity"); it was also pretty oversized needing an ambitous downsizing in a context of thick and sebaceous skin (which normally has difficulties to shrink after nasal reductions)-all the former aims to make understandable that such cases are firstly difficult technically and suitable for high end surgeons and not ones applying standard nasal reduction procedures, you were the perfect case for a lengthy, delicate, creative and enjoyable (for those with skills) so called "structure rhinoplasty", research about this; also aims to set clear that your skin might have behaved disfavorably and this is not attributable to the surgeons who did the work-considering it is difficult to judge the quality of the work, however it is possible to assess the situation in the images posted (better ones might help) and the eventual issues needing correction and how to fix them if you underwent another revision rhinoplasty; this comes next-your nose is not a crooked one, let's be careful and judicious using the terms; crookedness is used to define noses with a C shape after, normally, major nasal traumatism, some botched rhinoplasties and also congenital issues; yours is just slightly asymmetrical and currently the swelling is more predominant on one side, which leads to your subjetive belief of crookedness; I understand your frustration with my disagreement, however knowing it is, the most likely, just a virtual and temporary effect may ease this feeling; be patient and let's see the evolution, to be honest and with vast experience in my hands, I don't envision crookedness as a reason motivating a revision for your nose-your dorsum is indeed pinched, specially the supratip, very artiificial, due to reasons not within my current understanding but perfectly visible during open revision; this is a good reason for a revision, rebuild of the middle vault is required in your case, eventually using spreader grafts very carefully calibrated-there is a slight inverted V deformity, could worsen in a few months, if necessary can be treated-the tip is very poorly supported, prone to collapse and totally undefined, this is the most difficult and important part for your future revision, you need a surgeon who is very very good at this-the most tricky and uncertain part: poor contraction of the skin at tip and supratip; this is due to the thick features of your skin and, as I said, not due to technical deficiencies; if this persists after the stabilization period and is a confirmed issue there are 2 options to correct it; 1) theoretically only but never applicable: trimming away skin wedges leaving scars; obviously if the skin is in excess and does not shrink one solution might be cutting it away, however this is sheer theorization and not a real technical indication due to the scars involved, at least not in your case; 2) augmenting or raising the supratip dorsum and providing firm projection to the tip, and this IS indeed the solution when the skin fails to shrink at tip-supratip and appears a hollow polly beak deformity due to that cause-the animation of your tip when you smile is corrected by trimming the depressor of the columella, a tiny muscle-I notice, correct me if I am wrong, you never got alar flare reduction, IMHO you really need it to balance your noseNot much else can be said at this stage and with those images.Seek the advice and hands of a serious professional who offers to you a time-consuming and expensive procedure; stay far from minimally invassive snake-charming procedures, synthetic implants, fillers, wrapped diced cartilage, etc.
Difficulty 6-9 out of 10 in revision rhinoplasties, surgical time about 4-6 hours (in expert hands, could be even longer).
See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

Ritchie Younger, MD · Answer

I think you have answered your own question in the first paragraph of your remarks.  By your admission, it took about 18 months for swelling to subside after your first rhinoplasty,  Typically, for a second rhinoplasty-I advise patients that you may want to add 6 months to the healing time for every rhinoplasty after the first.  Thus-you probably will need at least 24 months for things to settle out after this (being your second nose operation),  quite dependent on exactly what was done during both of the surgeries.  As a surgeon who performs a high volume of revision rhinoplasty procedures-I gotta say that the homework assignment for all who inquire about rhinoplasty issues-please check out the credentials and experience of your selected surgeon!!!!!  On Monday of this week I performed 5 rhinoplasties-four of them were revisions of other surgeons work.  Three of these revisions were complements of colleagues  who were not Board certified in Facial Plastic Surgery, and the other was from a surgeon who indeed is Board Certified, but 95% of the surgeries that he does are breast augmentations. Would I send my wife to him for nasal surgery? Obviously not...but he would be high on the list for Breast Augmentation-since he does great work.  Do your homework to authenticate that your selected surgeon has vast experience handling your specific problem!...for your own sake!!!And back to your question-at 3 months could my columella hang a bit much and the nose be crooked-due to swelling- at 3 months....you bet it could !!!Good luck to you and happy healing !!

Richard Mark Winters, MD · Answer

you have a sagging tip for sure....this ‘pollybeak’ deformity requires tip support, release from nasal depressor muscles, etc....if your third time is to be a charm, take your time finding a revision rhinoplasty who has many years or experience, a practice focused on rhinoplasty and a proclivity toward revisionsGood luck....

Robert Graper, MD · Answer

Swelling can definitely be asymmetric causing a temporary appearance of the nose being crooked. So sit tight and let time determin if it is swelling or an actual deviation of cartilage a/o bone. You do not have a hanging collumela to begin with so it has not been corrected. You have what looks like a tip that plunges when you smile. What is actually happening is the sides of your nose elevate when you smile and your tip does not giving the false appearance of a drooping tip. Your collumela is fine. The tip does appear full but that can also be swelling 3 months post op. Stay connected with your surgeon. Good luck.

Can hanging columella and crooked nose 3 months after revision rhinoplasty be caused just by swelling? (Photos)

Answers (4)

Answer: Post revision changes

Answer: Post revision changes

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Can hanging columella and crooked nose 3 months after revision rhinoplasty be caused just by swelling? (Photos)

Answers (4)

Answer: Post revision changes

Answer: Post revision changes

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.