Can a plumping graft be added to a retracted columella under local anesthesia ?

Question

Primary rhinoplasty left me with a retracted columella , a bulbous droopy tip and I need to fix that . Is it possible to do that locally and with closed technique ? Thank you doctors !

Thomas A. Mustoe, MD, FACS · Answer

Tip rhinoplasty which is what you need to properly address your concerns can be performed under local anesthesia supplemented by oral sedation as an office procedure, but the best results would be with an open approach with allows more precise correction.  With closed rhinoplasty you can't  see the tip cartilages and so you  have fewer options for correction.

Steven M. Denenberg, MD · Answer

First of all, a bulbous droopy tip needs to be narrowed and elevated -- sometimes elevated a lot -- and that involves complicated work on the cartilages that form the tip of the nose. A plumping graft wouldn't bring the tip up or narrow it at all. And if your tip is really droopy, the plumper might make the nose look *longer*, and finally, elevating the tip might take care of the retracted columella without any plumper.
That's a lot to say without photos! I'd love for you to see an excellent set of morphs of what might be done to your nose. It'd help your understanding a lot.
The woman in the short video that I posted with this answer had the tip of her nose elevated and narrowed substantially in her revision operation.
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for the question and provided information. If provided, photos for online evaluation would help more and based on the information you shared; yes, your nose can be improved by Closed technique which provides maximal healing and eliminates a scar on your columella. General anaesthesia is preferred for patient's comfort and your case needs a full revision rhinoplasty procedure. An exprienced, innovative surgeon can perform well balanced, natural and desired look.Best Regards,

Toby Mayer, MD · Answer

Plumping graft under local anesthesia. Very often more than this is needed and therefore general anesthesia is needed.

Umang Mehta, MD · Answer

Thanks for the question! I’d suggest bringing up your concerns with your primary surgeon or seeking consultations with 2-3 revision rhinoplasty specialists. It’s possible to both lengthen the columella and lift up a droopy tip by placing a caudal septal extension graft. This is usually made of septal or rib cartilage. Depending on the exact cause of your bulbousness, trimming and/or narrowing the tip cartilages plus scar tissue excision might be indicated. Without examining you in person, I can’t say for sure, but I’d likely recommend an open approach under general anesthesia or twilight (IV) sedation. You would want this to be your last ever nasal surgery, so don’t cut corners in trying to do a more limited approach. Kind regards,Dr. Mehta

Jeffrey Jumaily, MD · Answer

The short answer is it's possible. Of course, we would need to do a full exam and see where the deficiency is and where the cartilage for the graft can be taken from. best wishes

William Portuese, MD · Answer

Trying to perform a rhinoplasty under local anesthesia is not a good idea, since it will be very painful and most patients cannot tolerate it.  In our practice, we perform all rhinoplasty procedures under general anesthesia.  After your primary rhinoplasty, it is important  to know how much cartilage is left over on the inside of the nose for potential grafting purposes.  The donor site and the recipient site will both be completely numbed up.   It is also best to address the droopy tip, the bulbous nasal tip as well as a retracted columella all at one time under one anesthesia with one recovery period. This can certainly be performed with a closed rhinoplasty approach.  Look for a surgeon who specializes in close rhinoplasty technique.

Hong Ryul Jin, MD · Answer

Plumping graft does help to augment the acute nose-lip angle but it does not lengthen the retracted columella. I need to see the photos first, but I assume retracted columella needs mostly septal extension graft to push down the retracted portion. Slight retraction may improve with grafts on the columella. Droopy bulbous tip can be fixed with closed approach but it also depends on the degree of deformity. Considering revision, retracted columella, droopy bulbous tip, your nose may be better correced with open approach. Thanks.

Michael Elam, MD (retired) · Answer

Dear Thoughtful9868, A graft can be done under local anesthesia however from the description of your concerns and the discussion of a "droopy tip" it sounds more involved and would require anesthesia. Seek some consultations with experts in the field to discuss your options. Best regards, Michael V. Elam, M.D.

Richard W. Fleming, MD (retired) · Answer

If just a graft to the columella will correct the problem this can be done under local anesthesia. However, if you have a "droopy" tip more work would be necessary  requiring at least sedation for most people.

Can a plumping graft be added to a retracted columella under local anesthesia ?

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