Is it possible to round out and fix a columella double break from an extended shield graft? (photo)

Question

Is it possible to round out and fix a columella double break from an extended shield graft? I want it to be one smooth line instead of dipping inward. I don't want to move my SEG any lower at the base. Is a tiny piece of perichondrium enough to smooth this out? I attached pictures of what the double break looks like vs how i would like it to look (notice the base of my columella has not been lowered any further down onto my philtrum).

Eric M. Joseph, MD · Answer

Unfortunately, I cannot tell the difference between the two photos that you posted. Sometimes, we can permanently improve upon somebody's nasal base with microdroplet Silikon-1000 injections, however, since it's not clear what you're looking to achieve, you would require an examination. Thank you for this question. Sincerely, Dr Joseph

Gerald Minniti, MD, FACS · Answer

I agree, a subdomal graft of temporal muscle fascia or crushed auricular cartilage will soften the columellar-infratip lobular angel.

Gary M. Horndeski, MD · Answer

The extended shield graft overlies the medial crura.  The medial crura can be shaved down to decrease the break point that you dislike.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Based on this photo, it is very likely that a small amount of filler to stretch the brake line(s) would be a good starting point. Fillers have a tendency to last very long in the nose. It may be worth of trying. Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photograph, you may benefit from a columellar onlay graft to help achieve this. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Sean Fisher, MD · Answer

If you are otherwise happy with the positioning and appearance of your nose- a small graft would likely give you the result that you are hoping to achieve. You could consider a small amount of filler to this area if you are hoping to avoid an operation, as the change is small. However if you are hoping for a more permanent solution a soft or crushed piece of cartilage or fascia in this area would give the desired result.
Sean Fisher, MD Aesthetic Plastic Surgeon Seattle, WA

Steven Schuster, MD, FACS · Answer

fixing the columella break can be very difficult and only make matters worse.  The deformity that your seeing is really quite minimal and although it probably could be done it would require someone with a lot of experience in doing open rhinoplasty and cartilage grafting.  Again good luck in your choices,
 Steven Schuster MD FACS
 Boca Raton Florida

Is it possible to round out and fix a columella double break from an extended shield graft? (photo)

Answers (7)

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