Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible? (photo)

Question

I had open rhinoplasty 25 d ago to refine the tip and small hump. now my nostrils are more uneven than pre-op, and columella is deformed and getting worse. My left nostril became distorted and everted. I had alar and spreader grafts and c. strut, due to thin skin i had crushed cartilage padding of the tip that is showing sunken spots. Surgeon offered immediate revision and possible removal of grafts or wait one year - as a rule. It may get worse with time. Is early revision contraindicated?

Aaron Stone, MD · Answer

The longer you can wait for the revision the better off you will be, the easier the surgery will be and the lower the risk of complication will be. When I was a resident I reoperated on a rhinoplasty patient early to add something to the first operation rather than to correct something. The amount of swelling/edema was so great once I was inside doing surgery that I still remember it decades later but from the outside you could not appreciate it. The best thing you could do now is get complete copies of your operative reports so future surgeons will a frame of reference to work from. Your before surgery photos show valve collapse so graft removal may not be a good option.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there

	Your question is interesting. In general it's better to wait a year before a revision, as others have said.  However, I wonder if your nasal bones are displaced along the bridge.  At 25 days, there might be enough mobility in them to reposition them as we would do in a closed nasal fracture reduction.  If there's any movement in them, it will be much easier to do this now than later when they're solid. It's hard from your picture to see if this is truly a problem, as your photo is not taken absolutely straight, but it looks to be a possibility.

	I would recommend you ask your surgeon to have a close look at your bridge and nasal bone position, and if it is not symmetric then have it straightened up now.  The tip, as others have said, might be better to wait on until it's settled.

	Good luck.

Mark Beaty, MD · Answer

From your photos it appears a revision may be necessary.  At this point there is too much post-operative inflammation and swelling to safely and accurately perform revision surgery. I recommend waiting 6 to 12 months.

Steven Wallach, MD · Answer

Sorry to say but I see what you are talking about. Without being in the surgery and seeing you in person, I would say follow closely with yoru surgeon, and seek other opinions in the future once things have healed.

Darryl J. Blinski, MD · Answer

Sorry for your post operative issues and YES I see them on the posted photos. Very hard to advise via the internet. Best is to obtain IN PERSON second opinions. In some cases early revision is advised but most are a wait and see issue for at least 9 months. My guess is early revision but again I have not examined you in person.

Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible? (photo)

Answers (8)

Answer: Columella issue

Answer: Columella issue

Answer: Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible?

Answer: Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible?

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Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible? (photo)

Answers (8)

Answer: Columella issue

Answer: Columella issue

Answer: Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible?

Answer: Crooked Columella and Tip Revision Less Than 4 Weeks After Rhinoplasty - is It Possible?

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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.