Are there instances where columellar strut grafts are too long or placed too low?

Question

Hello. I am 6 months postop and my columella is still very stiff and the base of my nostrils on either side of the columella are elevated. I can no longer see the tops of my front teeth when I smile, and when lifting up my lip, my gums are very hard to reach due to resistance from my nose. For this reason I'm scared to get dental work done. I'm wondering if this might be a permanent issue? Thank you.

Nima Shemirani, MD · Answer

Hi @gmc54321! The answer is yes and this can effect the smile. You are still early on in your healing journey. If this continues to be an issue after 1 year, the graft needs to be trimmed and adjusted. Best of luck. Dr. Nima!

Jeffrey Lisiecki, MD · Answer

To answer your question, yes there can be issues with a columellar strut graft being too long or placed too low. Alar rim retraction can also cause too much columellar show on the side view. You are only 6 months out so swelling should resolve further still. See your surgeon and discuss your concerns with them.

Eric M. Joseph, MD · Answer

In general, the placement of a columellar strut graft is determined during a physical examination. One finger is placed under your mid tip lip, and the other hand moves the nasal columella right to left. Swelling at the nasal base is common 6 months postop. Best to get reassurance from your surgeon. Hope this helps! Dr Joseph

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! Thanks for the questions. If the columellar strut or extension graft is too prominent, it can definitely effect the smile. It tends to cause a flattening near the incisors and sometimes a crease in the mid-upper lip. A 6 months, there could still be improvements if swelling is present. If no resolution by 1 year, then the graft needs to be trimmed and adjusted so you can smile fully. I would revisit with your surgeon to discuss your concerns. Hope this helps!

Zoran Potparic, MD · Answer

It is impossible to know what is going on with position of your columella graft without in person evaluation and operative report. This issue is best discussed with your surgeon; you should also ask for a copy of your operative report and present it to a surgeon(s) you may seek second opinion evaluation. All of these are best done in person. Good luck.

Ronald J. Edelson, MD · Answer

There are times when a patient can be overly conscious of the presence of a columellar strut for  the  very reasons you state. I don’t use columellar struts at all and I’ve taken several out in patients with your same complaints. Is simple to do and won’t cause any problems to simply have it removed

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Are there instances where columellar strut grafts are too long or placed too low?

Answers (6)

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