Lower Columella Missing After Rhinoplasty

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.

Doctor Answers 8

Columellar incision and open rhinoplasty

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The point you are referring to is the exact point of the incision for your open rhinoplasty.

The swelling above the incision accentuates the contrast. The tissue below the incision is minimally swollen. It will take a long time to resolve the swelling. At that time (six months) the asymmetry will be minimal.

Keep the faith.

Talmage Raine MD


Columellar Asymmetry

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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! 

Lower Columella Mssing after Rhinoplasty

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It apears you have a bad columellar scar after your open rhinoplasty procedure.This scar is rarely visible. I don't think anything is missing. A simple scar revision can be done in the near future.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Problems with a columella scar

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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.

Columellar incision gone awry after rhinoplasty

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The columellar closure and scar is an area of risk in open rhinoplasty, and though the columella heals for most with a barely perceptible scar there are time when things do not work out. This may be due to the skill of the surgeon, unforeseen events, or perhaps bad luck, but your surgeon should have a careful look. If you have lost confidence, a second opinion may help you set things straight.

Best of luck,


Columella irregularity after rhinoplasty

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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.

Rhinoplasty Revision

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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. 

Columellar concerns after rhinoplasty

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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.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 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.