How safe is it to trim and or remove a columella strut in a minor revision using only local anesthesia? (photo)

Question

2 questions..how safe is it to trim and or remove a columella strut in a minor revision using only local anestesia...second question....is it possible to completely remove a columella strut through a closed procedure..or its gets hard once you get to the tip area and only a majority of it can be removed...this is for a very problematic and painful clicking strut...

Roberto E. Garcia, MD, FACS · Answer

Thank you for your question. Handling a misplaced Columellar strut can be challenging. I have seen this in my practice in the past and I have found that managing the strut in Office can be done successfully. I personally believe that most of these procedures can be done via a closed approach. You should not have an issue if your surgeon is comfortable with  closed approach rhinoplasty. I hope this helps have a good day.

David C. Pearson, MD · Answer

In answer to your first question, it's generally quite safe and not uncommon to remove an annoying columellar strut graft under local anesthesia. As for the possibility or difficulty of removal it depends on factors such as degree of prior scarring from surgery (varies hugely) and how the strut was fixated (no sutures, dissolvable sutures, or permanent sutures like nylon). But generally it's not that hard to remove a strut completely if necessary.All the best,--DCPPearson Facial Plastic Surgery®

William Portuese, MD · Answer

Removing the columella strut is not a minor revision. Revision rhinoplasty is more difficult than a primary rhinoplasty,  And we perform them under general anesthesia for patient safety and comfort. It is possible to remove the strut with a closed rhinoplasty approach with all the incisions placed on the inside of the nose.

Steven Wallach, MD · Answer

Its s possible in some instances to make minor adjustments under local. It might be easier if you are sedated, relaxed, and more comfortable during the procedure.

Harry V. Wright, MD · Answer

An experienced rhinoplasty surgeon should be able to adequately numb the region in question for an adjustment or possibly removal of a problematic columellar strut without a deeper level of sedation. An oral sedative could be used to make you more comfortable during the procedure. Talk to your surgeon about your options.Best wishes!  Harry V. Wright MD, Sarasota, Florida

Daniel Greenwald, MD (in memoriam) · Answer

For an uncomplicated minor adjustment of the columella an office procedure under local anesthesia may be just fine.  This is dependent on the skill and experience of your surgeon (insist on seeing a doctor certified by the American Board of Plastic Surgery) and on the state of your nose.  If you have had  prior surgery then timing will be important, as will the presence of scar tissue.  If your nose is "virgin" then the safety of a "minor" office procedure will depend on how much work actually needs to be done.  If you choose an experienced, qualified, mature physician you will be fine.

How safe is it to trim and or remove a columella strut in a minor revision using only local anesthesia? (photo)

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