Please give me some advice. Very swollen infratip at 4 months post-surgery. Is it normal? Will it get better in time? (Photo)

Question

I had a revision open rhinoplasty 4 months ago. The first surgery was closed. My infratip area is very asymmetric with a big difference between the area above and under the scar. No improvement with the passage of time. After surgery in the first 3 weeks things looked normal. What happened? Can it be fixed? My infratip looks cut in two and the scar is very visible at 4 months. The infratip is very hard and there seems to be a slight excess of skin. Last picture is at 2 weeks and everything was ok.

Alejandro Nogueira, MD · Answer

The first weeks things were not that ok but neither as bad as they are now, just swelling did not let you visualize the underlying work, neither did it to me.
I'd need to see better images and know in detail the surgical techniques applied, and if possible also view your preop images. Anyhow so far I can tell you a few things with high chances of being trustworthy:
-I'd bet you got a tip graft which, unfortunatly, has been oversized or sized with poor judgement, it is obvious the tips of it and its protruding effect; additionally it was not properly shaped or weakened, if the tip graft is too flat and rigid it looks fake and there is an obvious "piece of something" inside the tip; a well done tip graf is awesome, the most lovely and nicely shaped tip, but needs skills, experience, handicraft patience, aesthetic judgement and understanding of its (beneficial and jeopardizing) powerful effects; so, first conclusion that tip needs revision
-additionally the tip excess produces 2 unsighty effects: a supratip prominence (aka polly beak deformity) and a protruding infratip lobule, the latter is the cause for your stepped columella; step aggravated by the fact your septum is short and sunken... which, itself, is unclear wether is due to your genetial preop structure (which has been unaddressed, and should have been) or a iatrogenic effect (unsuitable trimming of the caudal septum); I am prone some maneuvers went wrong with your septum because you received a septoplasty as well, so... you may need reconstruction of support and addressing the sunken columella by means of caudal extension grafts
-furthermore about the tip graft (yours is a perfect example of how powerful, to the good and the bad, may be tip grafts), you preoperatively had a pretty long and overprojected tip; this over projection has been left untouched, or in the best case minimally deprojected... and one of the (sometimes unknown by surgeons) effects of the tip grafts is adding as much length as thickness they have (between 0,8 to 1,5 mm)... so in the end you got a over prominent tip legth named in medical books (no offence intended) "Pinoccio's nose"; yes, a mess the whole your tip needs revision-may you have an oversized and overprojecting columellar strut? seems so...
-some swelling has to subside to confirm if you have a bit of open roof deformity and suboptimal osteotomies, this is just am unconfirmed suspect, if confirmed would need necessary revision
Let me insist that 4 months is not long time to be concluding, but enough to begin issuing some assessment and prognosis, which is unfortunately pointing to a revision. It is also unclear if you have one or more than one tip grafting, or even you have no tip grafting and all is a consecuenque of tip plasties.
Anyhow it is likely another revision is bound, do research well reputation and experience in complex rhinoplasties, will be a very difficult procedure, there (almost) does not exist so called "mini revisions". Yours would be second revision, and believe me... revisions are a real technical challenge and even an ordeal for surgeons, very few do devote to them with all their soul, even having the right skills.
If you wish better grounded opinion please do post or send privately successive (every other month) well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Sergio Pasquale Maggi, MD, FACS · Answer

Hello,Your question is very commonly asked, particularly after a revision rhinoplasty.  This is normal tissue swelling that settles in the most dependent position- the tip and columella.  I have see it last months. It can be particularly prolonged on redo cases I have found.  But with careful attention to detail it should resolve.In my practice, I recommend regular gentle massage of the area to improve circulation, and a salt restricted diet.  This combination seems to help hasten the resolution.Best,Sergio Maggi, MD, FACSdrmaggi.com

Fred J. Bressler, MD, FACS · Answer

Thanks for your post. Soft tissue swelling often does occur in the region about the columellar incision and typically will improve over time. However, if a cartilage graft was placed here and this is the cause of your deformity, then your surgeon may need to consider removal or modification of the cartilage graft. Additionally, sometimes the incision requires a minor scar revision. Discuss your concerns with your surgeon and ask about soft tissue swelling vs cartilage graft. Fortunately, either way this problem could be corrected if necessary.

Please give me some advice. Very swollen infratip at 4 months post-surgery. Is it normal? Will it get better in time? (Photo)

Answers (3)

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Everything you need to know about Revision Rhinoplasty

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Please give me some advice. Very swollen infratip at 4 months post-surgery. Is it normal? Will it get better in time? (Photo)

Answers (3)

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.