Swollen tip and columella 9 months after septorhynoplasty and tip reduction surgery. Will this improve? (photo)

Question

I had my surgery in June 2018 and was told by my surgeon that it would take 2 years to see the final results due to my thick oily skin. I am overall pretty happy with my results but my columella is stiff and droopy. The surface of the tip also appears a little uneven in some photos. I was wondering if this would improve anymore in the next year and if anything could be done to speed up the process e.g. steroid injections?

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for question and photos you shared. As you mentioned with nine months post-op you are in your healing phase which can take up to 2 years since you have oily and thick skin. Edema and swelling, you will have untill your final result.After your final shape if you are dissatisfied, a revision rhinoplasty to improve your nose for better can be performed. By Closed and Atraumatic Technique you will not have a cut on your columella, tissue damage will be prevented.Best Regards,

Philip J. Miller, MD, FACS · Answer

You have to give yourself some more healing time.  Your nose and surrounding areas are going to be swollen for a while and you should be consulting the surgeon that performed the procedure. It can take up to a year for final results.
Sincerely,
Philip J. Miller, MD, FACS Double Board Certified Facial Plastic Surgeon

Steven M. Denenberg, MD · Answer

Of course, all I have to go on is these photos, but even right after surgery, it seems your tip was very low, making the nose look long. And now at nine months, it's really no shorter. In fact, it's rare for a nose to elevate after surgery -- usually a nose gets longer as the swelling decreases. 
If you consider a revision, I would see to bring the tip back a little closer to your face, and to elevate the tip -- elevate it more or elevate it less, depending on your tastes. The woman in the short video that I posted with this answer had the tip of her nose elevated substantially in a revision operation.
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes I described above require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. For those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! 
But remember, you're not the surgeon for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.

Thuy-Van Tina Ho, MD · Answer

Dear jessicanicole98,
Thank you for your question. It is difficult to make an accurate assessment and recommendations based on photographs alone. I recommend you seek serial re-evaluation with your surgeon who can perform a thorough evaluation and discuss with you the best surgical treatment options to meet your goals. A great deal of swelling after surgery goes away within the first month after rhinoplasty but gradual improvements or even fluctuations continue to occur months to a year or so out. Residual swelling can be managed by maneuvers such as steroid injections, taping, and manual pressure exercises. If the persistent deformity is due to cartilage/structural issues rather than just soft tissue swelling, your surgeon can discuss with you what other treatment options including revision surgery are possible.

Michael Sundine, MD, FACS · Answer

I would agree with your surgeon that in thick and oily skin the tip of the nose may remain swollen for a longer period of time.  Please follow up with your surgeon to see if some steroid injections may be of value.

Swollen tip and columella 9 months after septorhynoplasty and tip reduction surgery. Will this improve? (photo)

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