Lower Columella Missing After Rhinoplasty

Question

I am 5 weeks post open rhinoplasty. The lower part of my right columella appears to be missing! Rather than vertical, the columella is diagonal with the left much lower than the right. The photo is of my right side and there appears to be no columella below where the incision is. I can't imagine this is a swelling issue. Does this ever resolve itself or should I start researching a good revisionist? Will I really have to live with this for a year to have a redo? Many thanks for your input.

Ronald Schuster, MD · Answer

It's difficult to tell with certainty what's going on but it looks like a "step off" below the scar. The skin looks like it was not aligned as best as possible. Occaisionally swelling can give an appearance something similar but not usually quite this obvious. Check with your surgeon and explain calmly your concerns. If it is a clear cut misalignment than you could have a scar revision probably by 3 months after surgery.

Paul K. Holden, MD · Answer

Five weeks after surgery, visible columellar asymmetry is probably going to stay that way.  It is important for you to decide if this is noticeable enough to desire an additional procedure to repair it.  Based on your photo, it appears that you have plenty of columella below the incision, but the right side (I can't say anything about the left without seeing it) is widened or flared.  This can be due to the footplate of cartilage in this location, which can have a natural flare to it, or other cartilage based causes such as a misplaced graft.  In rare cases, a small collection of fluid can even be present.  This warrants close inspection by your surgeon.  In any case, it is not usually necessary to wait a full year to revise this area.  This, however, depends on what your original surgeon is comfortable with.

	I hope this helps!

Thomas A. Lamperti, MD · Answer

From looking at your nose from that angle alone it's hard to say what is going on exactly. Some patients can get  quite a stepoff at their columellar incision, due to tissue swelling above the incision.

	There is a possibility of developing columellar retraction. I would check with your surgeon to get a better assessment.

Steve Laverson, MD, FACS · Answer

Again, without having performed the procedure and examined you in person, it is impossible to offer the best information.  In general, from your complaint and the photo, I believe you do NOT need to wait a year.  The irregularity may be related to underlying septal, medial crural, or columellar strut graft issues.  If it is only related to the way the wound was closed, this is an easy office revision.  If there is a true shortage of columellar skin, perhaps a Y to V type advancement can improve.

Scott Trimas, MD · Answer

It is a bit unusual to not have a normal appearance of the columella five weeks after an open rhinoplasty but not unheard of. It may be swelling. I would discuss your concerns with your rhinoplasty surgeon and if a revision is required, it is best to wait at least six months and close to one year depending upon what needs to be done if anything.

Lower Columella Missing After Rhinoplasty

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Answer: Rhinoplasty Revision

Answer: Rhinoplasty Revision

Answer: Columellar concerns after rhinoplasty

Answer: Columellar concerns after rhinoplasty

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Lower Columella Missing After Rhinoplasty

Answers (8)

Answer: Rhinoplasty Revision

Answer: Rhinoplasty Revision

Answer: Columellar concerns after rhinoplasty

Answer: Columellar concerns after rhinoplasty

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.