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3.5 Years Post-Op — Thick Skin, Persistent Tip Swelling and Columella Concerns. What are my options for revision? (Photos)

Raya2323Nov 24, 2025
Hi doctors, I’m 3.5 years post primary rhinoplasty and still dealing with a persistent issue that’s really bothering me: my columella looks heavy, swollen, and slightly hanging, especially from the profile view. The entire tip area still feels firm and rubbery when touched, and the swelling never seems to fully settle. My concerns: • Why does the columella still appear thick or bulky this far out? • Could this be scar tissue, excess cartilage, poor support, or leftover swelling? • Is this something that realistically can be corrected with a revision, and what approach would help refine or lift this area? • For someone with thick skin, what techniques or strategies usually work best to create a more defined, lighter-looking columella and tip? I’ve attached multiple current photos from different angles. I’d appreciate any honest medical insight or recommendations. Thank you in advance

Answers (1)

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Dr. Richard G. Reish, MD, FACS
Board Certified Plastic Surgeon
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Answered on Nov 27, 2025
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Richard G. Reish, MD, FACS

Hello and thank you for your question. Based on your photographs, there are many ways to add tip projection including soft hybrid cartilage-fascia tip grafts, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a...

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Richard G. Reish, MD, FACS

Hello and thank you for your question. The final results take at least 1.5 years for the swelling to fully resolve. This can require lots of patience and waiting. Steroid injections performed by your surgeon can be extremely helpful. I usually start steroid injections around 1 to 2 months...

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Richard G. Reish, MD, FACS

Hello and thank you for your question. Based on your photographs, there are many maneuvers that may help you in a revision, including re-tensioning the tip and placement of extended alar contour grafts . With good surgical technique, you could have an outstanding result. I recommend that you...

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Jeffrey H. Spiegel, MD

Bone paste or bone grafts can be done do fill in bony areas, and sometimes the bone can be moved and stented in place with biodegradable materials to support it while it heals.

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Andrew Miller, MD

Based on your photos, you can certainly make an improvement. The bridge can definitely be raised, and the tip can be brought down some. It probably won't be as far down as it was before, but you should be able to get rid of that Barbie look. Be sure to see a rhinoplasty expert for consultation.

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Andrew Miller, MD

Based on your photos, you are a good candidate for revision rhinoplasty. The tip still looks somewhat wide and long. So with a well performed tip rhinoplasty, you should be able to make it smaller and shorter while keeping it natural. Be sure to find a rhinoplasty expert for consultation.

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