Crease when I Smile from Stiff Columella

Hi, I had a closed rhinoplasty 12 days ago, and I know it's early and still swollen and needs time. I'm just worried and I want to make sure that what I'm seeing is normal at about 2 weeks post op. My columella is very stiff and it seems too long. It "hangs" about 3mm past the tip of my nose into my upper lip, creating a very unnatural crease when I attempt to smile. Is this just due to swelling, and something that will become more natural and normal over time? I look so weird. Thanks.

Doctor Answers 8

Lip crease after rhinoplasty

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The crease you mention is likely from swelling in the area. Ask your surgeon about it. Depending on what was done a time frame for seeing change to the area can be given. Stiffness is common to the columella, especially if a cartilage strut was placed.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

You look good!

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Everything feels firm and hard this early after rhinoplasty. Don't judge yourself this soon. Talk to your surgeon about how he or she sees the healing process going depending on the maneuvers performed.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Wait for Rhinoplasty Swelling to go down

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Honestly, with over 20 years experience performing Rhinoplasty...this is most likely due to post op swelling from your Rhinoplasty as you are fresh post op at only 12 days.  Try to relax and let yourself heal...and by all means ask the surgeon at your next post op visit to alleviate your fears.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews


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At 12 days it is way too early to see how your lip and nose react to normal movements. Right now it is swollen and stiff and needs time to settle down.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Creases aren't cool

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Luckily, you can count on swelling playing at least some part in the crease you are seeing.  Give it some time, at least a month, and more likely several months.  Ask your surgeon about it as well.  If he (or she) did extensive work in that area, especially in an attempt to reconstruct or lengthen that area, then it may be permanent, but I wouldn't stress about it yet.

Colin Pero, MD
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 15 reviews

Lip creasing with smile after rhinoplasty

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Though we cannot confirm, it appears that your closed rhinoplasty may have included a graft to the area of the nasal spine at the base of the nose. The graft will open the angle between the lip and the nose, though can restrict the upward motion of the lip when smiling, thus the fold in the lip midway. At twelve days, it could be swelling alone, and either way it pays to wait until the tissue softens more. Ask your surgeon if a graft is in place, it is reversible if necessary, and often by six months all will be well, no more fold.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Swelling after rhinoplasty

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Dear Allison,

More than likely, it is just swelling after your rhinoplasty.  It is still very early in your post-operative course and things should soften a little and make it easier to move your upper lip as the swelling drains.  Due to the effects of gravity, it may take a little longer for the columella swelling to come down.  Just be patient and if it is still there after a few months, then bring it up to your plastic surgeon.

You'll see that as the swelling comes down, the columella will come up to the normal 1-2mm show.


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Stiff Columella and Upper Lip Crease 12 Days after Rhinoplasty

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It is not normal, but post-op swelling can cause temporary stiffness of the columella and the crease in the upper lip. This should improve during the next 3-4 weeks.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.