Indentation in Bottom of Nostril, Left After Rhinoplasty, Why is This? (photo)

Question

I got a rhinoplasty a month ago and there is a huge indention in the nostril base on the left side. It makes my profile from the left look much worse than the right... Even if the doctor 'smooths it out,' how will this raise the indention? He almost gets offended when I ask about it. Has anyone ever seen this? I completely did not expect this. Trent

Jaime Perez, MD · Answer

Though it is difficult to tell from your photos and without knowing the intraoperative details of your surgeon, it appears that the indentation you are seeing is a result of scarring from an open rhinoplasty.  Your nose and scars will continue to change and improve a significant amount over the next year, thus it is too early for any type of revisionary or corrective procedures.  If, however, after a year you are still unsatisfied, you may consider scar revision, dermal fillers, or even micro fat grafting to fill out the indentation.  In the meantime, relax and try to be patient.  

	Jaime Perez, M.D.

	Plastic Surgery Center of Tampa, Florida

	Rhinoplasty Specialist in Tampa, Florida

Howard Webster, MBBS (Hons), FRACS · Answer

If you had an open rhinoplasty, it can only be a little separation of the scar on that side leading to a depression in the tissue under the scar.

	I suspect that it will not spontaneously go away, although as your obvious significant swelling reduces it might become less evident with time.

	The main point to appreciate however is that it is easily fixed with a minot revision of that scar point, even under local anaesthesia in the office.

	It is real, and present, but no ones fault.  However carefully your surgeon sutures the incision, from time to time a scar will occur which needs touching up.  The key is that your concerns are validated, and the small problem addressed when the swelling reduces. 

	All rhinoplasty surgeons in practice need very occasionally to touch up a scar.

	Good luck.

Toby Mayer, MD · Answer

Rhinoplasty takes 6-12 months to heal and the swelling to go down. If after at least 6 months it is still dented you will need it revised.

Mario J. Imola, MD, DDS · Answer

The indented area at the the base of the columella where it meets the nasal sil (nostril base) is most likely a 'relative' depression.  In other words, the columellar skin was dissected and remains significantly swollen at 1 month following rhinoplasty.  The nasal sil region was not dissected and did not suffer nearly the same degree of swelling.  Hence the columellar skin stands out further than the nostril base.  In time the contour should significantly improve.  If they are not still to your liking then a minor revision procedure will be necessary.

	Mario Imola, MD, DDS, FRCSC.

Steven Wallach, MD · Answer

The idnentation after rhinioplasty may be realted to the palcement of the incision during open rhinoplasty. The scar does go through changes and it may improve.

Darryl J. Blinski, MD · Answer

The photos does show an indentation in the nostril sill. Most likely a surgery issue caused this. Try a filler or even scar revision as a plan.

Daniel Del Vecchio, MD · Answer

Im guessing but you may have had an open rhinoplasty, with cartilage grafting.  The distal most tip of the columellar skin flap is therefore the area under greatest tension and has the worst blood supply.  In the area of the nostril sill it is not uncommon to have a depression or notchin.  This effect can be due to swelling of the tip of the skin flap, which subsides over time.  Worst case scenario,  filler such as restylane or even micro fat grafting can take care of this.  Best Regards,

	 

	Dr Del Vecchio

Richard W. Fleming, MD (retired) · Answer

This indentation in the nostril sill may improve as swelling resolves over the next 9-12 months. You can consider a filler in the interim, but a revision may be necessary.

Michel Siegel, MD - Account Suspended · Answer

It appears that what you are referring to, is the area where part of the incision was placed during surgery.

	The indentation could be from several causes, such as swelling, a suture having broken loose, healing, and incision placement, among others.

	Since you are only a month from surgery , I would wait for the swelling to go down, If still there, dermabrasion, or scar revision can be done to camouflage the incision better.

	Best,

Indentation in Bottom of Nostril, Left After Rhinoplasty, Why is This? (photo)

Answers (9)

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