Crooked Columella After Rhinoplasty

It has been over 8 months since my open rhinoplasty. I am left with this. What happened? Can I possibly fix this assymetry? My doctor kept saying it's swelling and to massage it. It's hard and a little numb one the right side.

Doctor Answers 9

Crooked Columella May Require Revisional Rhinoplasty

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A crooked columella after rhinoplasty could be due to a septal deviation, a malpositioned columellar strut graft or even tip cartilages that have twisted with scarring or initial placement. Now that it is nearly nine months after your initial surgery, it is unlikely that major resolution or improvement is going to be seen with more time. This would indicate that revision for improvement will be needed. At this point waiting until a full year surgery before revision is not much longer. Go back at one year and discuss with your plastic surgeon your concerns and hear what he/she has to say. If not happy with those answers, it is time to get a second opinion. 

Columellar asymmetry

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The cartilages that make up the columella are the medial crura.  It looks like you may have a deformity of these cartilages after manipulating them with sutures or excision.  Discuss with your surgeon for any need for revision.  

A well-performed Injectable Filler procedure may be helpful in restoring symmetry to the base of your nose. Video attached.

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I read your concern and reviewed the up-close photos of your nose. On your front view, the right side of your columella hangs a bit lower than your left. In my view, you should reserve revision rhinoplasty surgery as a last resort.

You may be able to have restoration of symmetry by adding a small amount of volume to the left side of your columella. In my practice, I prefer Silikon-1000, an off-label filler for permanent results.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Crooked Columella

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It would be important to evaluate the base view of your nose to see if there is true deflection of your caudal septum and asymmetry of your nostrils. If the caudal septum is deviated this could be corrected with a revision surgery, perhaps in a closed manner. Also, the firmness should resolve over the next few months.

Sumit Bapna, MD
Columbus Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

Columella deviation

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Sorrry but it is hard to see the photo.  Other views would be helpful and of course a formal exam is importantt.  Sometimes the columella tips to one side because of a curved septum.

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

Crooked Columella After Rhinoplasty

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It appears that your nose was deviated before surgery; this could be from a deviated nasal septum.  The septum may or may not have been worked on, but often times if it is not, the deviation becomes more apparent.  Ask your doctor if septal work was performed.  You may need a revision, but best to wait a year until the nose is soft before performing any additional surgery.

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Columella problems after rhinoplasty

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A columella that is not completely straight after rhinoplasty is often due to a deviation of the septum, or possibly the shape of a graft placed in the columella to support the tip. My bet is the septum, and revision can improve the situation.

Best of luck,


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

Crooked Columella After Rhinoplasty

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on these pictures it is hard to fully appreciate the deformity .You should seek a second opinion by an experienced plastic surgeon.The latter will tell you  whether your concerns are well founded and how to go about managing it.

Erel Laufer, MD
Dunedin Plastic Surgeon
4.7 out of 5 stars 35 reviews

Crooked Columella 8 Months after Rhinoplasty

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If the deviation or asymmetry is improving, be patient for another 3-4 months. Regardless of the cause, if this persists it can be corrected by a surgeon experenced in revision rhinoplasty surgery.

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.