How can i correct columella twisting to one side resulting in asymmetrical nostrils? (Photos)

Question

Have had 3 surgeries, septorhino, sinus, nose correction. Doctor previously ruined the shape of my nose, it was bent with a hanging twisted columella but last surgeon straightened it and lifted the columella. However, it still twists to one side resulting in very visible uneven nostrils and dent in columella. Is it safe to operate again? Would it alter my nose tip? Happy with the tip and the rest of the nose. Just not the columella, dent and uneven nostrils.

Lucian Ion, FRCS · Answer

If your previously surgeries have failed to address this problem one has to assume that it requires a different effort to correct it.
My preference would typically be to use rib cartilage support in order to have adequate stability of the structure because the cartilages of the nasal tip also appear to be twisted, not just the columella.
The twist in the position and direction of the tip cartilages has a strong influence on the contour of the nostrils and contributes significantly to the asymmetry. The midline structure is critical for positioning of the cartilages of the nasal tip and if the lateral cartilages are either too weak or naturally distorted, they would not be able to stabilise in a good position on their own.
This is where the cartilage grafting can help to control the shape.

Gary Linkov, MD · Answer

Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. In your situation, the columella can be straightened but requires proper grafting material. 
Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.  
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

How can i correct columella twisting to one side resulting in asymmetrical nostrils? (Photos)

Answers (2)

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