Clicking after rhinoplasty. Could the graft be loose?

Question

I have a columella the strut placed for increased tip projection 2 months ago. when I smile or push on my lip, I can feel it click. I know this is sometimes common but could this be an indication that the graft is loose? I pushed on my nose a few weeks after surgery so I'm a little concerned. I talked to my surgeon and he said everything looks like it's healing well. would he be able to tell if the graft had shifted just based on a physical examination?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. I have seen this exact situation before.  The strut graft is moving and may need a slight trim.  I recommend you return to your surgeon and share your concerns.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

John Layke, DO, FACS · Answer

One of the complications with a columellar strut long enough to reach the anterior nasal spine (common for increasing projection of the nose) is that you may hear clicking when making certain expressions.  As long as there is no tip deviation, you don't have to worry.

Tanveer Janjua, MD · Answer

If there is a clicking with smiling but it does not effect the appearance or shape of the nose then you do not need to worry. Only if a deviation happens that the strut might need to re-adjusted. RegardsDr. J

Sachin S. Pawar, MD · Answer

Unfortunately, the clicking sensation you describe can occur after columellar strut placement and is a result of the lower part of the strut (at the base of your columella) sliding against the anterior nasal spine. This may improve with time as the complete healing process after a rhinoplasty can take up to 1 year. However, if it persists and is bothersome, I would recommend having your surgeon re-evaluate and determine if a small revision could help correct this. Good luck!

J. Andrew Bartlett, MD, FRCS · Answer

This can occur as mentioned below with certain expressions.  You probably did not harm the result when you pushed on your nose after surgery.  If there are no change to the appearance, not to worry.

Regina Rodman, MD · Answer

There is chance the graft is moving and causing the clicking.  As scar tissue forms, this may seal down and go away.  If the graft had really shifted, you would have noticed the tip off to one side and the nostrils asymmetric.  The doctor would also be able to tell by exam.  If it still looks good there is nothing to worry about.Best of luckDr Rodman

Steven Wallach, MD · Answer

Clicking can occur from a  columella strut placed.  Sometimes this can be corrected by trimming the base of the graft.

Robert H. Hunsaker, MD · Answer

So long as your nose looks good and is stable, this should not be an issue. An edge of cartilage is catching a bit on another piece of cartilage or bone during animation.

Michael T. Somenek, MD · Answer

The clicking simply indicates that the columellar strut is not secured down to the underlying bone. This doesn't mean that it is going to move as it is probably in a tight pocket.

Robert E. Zaworski, MD (retired) · Answer

I would avoid pushing on the nose.  It take weeks to months to heal from Rhinoplasty surgery.  Allow time to heal.

Clicking after rhinoplasty. Could the graft be loose?

Answers (12)

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