Will a columella tuck help my nostrils not show in front and on side profile? Or will I need a revision? (photo)

Question

Will I need a revision to get the "expectations photo" or can a columella tuck help the appearance of my nostrils? and de project my nose to not be so upward? it's been 8 months since rhinoplasty. Just wanted to know what my options are if I'm unhappy with my results after waiting a full year.

Alejandro Nogueira, MD · Answer

Yes, your wish pics are not only feasible... they are also a must, they are how your nose should have (overally) been made by present time.You suffered an over aggressive caudal septum resection, leading to an over rotated tip, piggy nose, a 75º unacceptable nasolabial angle and exposed nostrils. It does not exist a "columella tuck", let's go to serious concepts, please.You need quite necessarily a septal lenghtening, not an easy technique and only successful in very selected hands, do investigate and go wherever is necessary. Also seems your nose is pinched, the nasal valve affected and you need a repair over this area, likely with grafs like batten or other kind, diffcult to tell until the intraoperative revision by means of open rhinoplasty (a must in your case). A tip graft Sheen's style may be necessary as well, unclear now. The only certain thing is the need of lowering that extremely wide nasolabial angle, like in your wish pics... you are not overdemaning... you just want a normal nose, pretty understandable.You must now find a very good revision surgeon.

Zoran Potparic, MD · Answer

It is very hard to give a good evaluation of the nasal dorsum, tip, columella and lip relationship based on your photos. To me it looks that your columella is retracted? For that reason one can  not see your columella on profile view because it is hidden by your nostrils? Normal columella  should be about 2-3 mm in front of nostrils on profile view. So, if my evaluation is correct, you will need columellar cartilage graft which will push columella anteriorly and correct (increase) the angle between your lip and nose to 100-105 degrees. Whether you nose tip needs de-rotation or more projection should be decided after correction of retracted columella.You should discuss this delicate issue with an experienced plastic or ENTsurgeon with good reputation in revision rhinoplasty. Good luck.

Afshin Parhiscar, MD · Answer

Dear Rhinoplasty111From the pictures and what I can see, Injectable fillers might be able to blunt the transition between your tip and nasal ala, however, de-rotation would likely require a rhinoplasty. If you are considering surgery, dont use fillers as the technique for de-rotation will also blunt the transition between your tip and ala. Look for experienced and board certified plastic Surgeon. See more than one consult. Male a well informed decision.

William Portuese, MD · Answer

Yes, the columella can be tucked inwards. A columellar plasty involves removal of skin and cartilage from inside the columella with dissolvable sutures placed. The columella can be trimmed to raise the tip or lower the tip, depending upon where the cartilage and skin is removed.` For many examples, please see the video and  the link below

Dennis Barek, MD (retired) · Answer

I don't like the use of the term "columella tuck"However, your "after" nose is markedly shortened compared to the "before";  a columella procedure will not address this issue.

Richard W. Fleming, MD (retired) · Answer

Presently your tip looks over-rotated but this may improve over the next several months. I would not recommend a columellar tuck but rather decreasing tip rotation or lengthening the nose which would require a revision.

Will a columella tuck help my nostrils not show in front and on side profile? Or will I need a revision? (photo)

Answers (6)

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