2 years post op - what can be done to help correct my bulbous tip, drooping columella and occasional swelling? (photo)

Question

It’s been almost two years since I’ve my sinoplasty/rhinoplasty. I still have a very bulbous tip/drooping collumela that still swells occasionally. I have thick skin but was never told to tape. I’ve already gone through one round of steroid injections that gave me some temporary results. I’m now seeing some bumps on my tip which I am concerned might be scar tissue. Is there anything I can do now short of revision?

Ronald J. Edelson, MD · Answer

If you have a hanging columella and want the tip raised up it’s very straightforward  to do this. I do this through a closed approach. It’s very common to do this in a revision rhinoplasty.

Eric M. Joseph, MD · Answer

Unfortunately, the only method of elevating a droopy tip would be with Revision rhinoplasty surgery. Since you are two years after rhinoplasty surgery, I suspect that steroid injections might not be helpful, and could lead to visible irregularities. I hope this helps. Sincerely, Dr. Joseph

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photo It would be possible to make a more accurate evaluation if you could send your photos at 95 degree angles from the side and front profile, but as far as I can see from this photo, you have columella and I would recommend you a revision operation to get rid of this image.
It would be better face to face consultation.
Best Regards!

Anil R. Shah, MD · Answer

Several options are available to address your concerns, including starting a taping regimen, undergoing additional rounds of steroid shots, using laser therapy to address possible scar tissue, or applying a high-strength retinol to the nose. We have had amazing results with out patients using these methods.

Lexie Wang, MD · Answer

It's hard to tell from this one angle of picture. If you notice changres with steroids, then you should definitely keep trying it until they no longer work or until there are some of the less favorable side effects of steroid injection.

Oakley Smith, MD, FRCSC · Answer

Hi
It is better for you to consult with a facial plastic surgeon who can examine you and discuss the surgical procedure if needed and the post op recovery 
process.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It is hard to tell for sure based on your limited single photograph, but there are likely some improvements that can be made to help refine your tip definition and infralobular tip area. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Steven M. Denenberg, MD · Answer

When the tip of the nose droops after surgery, certainly after two years, nothing is going to elevate the tip other than a revision. Also, the remaining bulbousness, despite the fact that you see it swelling occasionally, is almost certainly the size and shape of the tip cartilages, because a persistently wide tip and a tip that is too droopy after an attempt to elevate it go together. That's good news, though, because it means that, in expert hands, a good elevation of the tip, and even narrowing, is likely. Elevation of the tip in particular is one of the more predictable changes to make, even in a revision. Again, in expert hands, that is.

I wouldn't have any more steroid injections. They are just extremely unlikely to do anything good, and it sounds as if they're telling you they might do something bad if you continue. Also, don't kick yourself for not taping the nose; I don't think taping does anything at all.

How *much* to elevate the tip, or narrow the tip, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, 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 that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. 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. And it also discusses how to take photos that are best for online evaluations.

And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment on the outcome of any plastic surgical procedure we need to see proper before and after pictures.
If you don’t have before, and after pictures to ask your surgeon to forward the pictures they took.
If the shape and contour of your nose, bothers you enough to have surgery then you may want to consider having revision surgery.
If not, then you should probably avoid having a revision.
Taping your nose isn’t going to change your outcome.
There’s no indication for further steroid injections.
At two years, your results are final.
There’s no longer inflammation related to healing.
We can’t really assess your outcome without knowing what you look like before.
Best,
Mats Hagstrom, MD

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