Alar retraction and hanging columella post-op, what are my options? (Photos)

Question

I am at 2,5 months post op. Columella strut graft was placed to fix hanging columella but it is a bit low and can be pushed up (Maybe suture broke?). I read that columella is easier to fix and alar retraction needs alar graft but I don't want to go for another extensive surgery. When i tape my nose from bottom it doesn't solve my problem completely but i have an improved apperance. Is it a bad idea to ask my surgeon to raise columella graft and forget alar retraction? Other suggestions?

Robert Kotler, MD, FACS · Answer

Dear lilla28 in Los Angeles, California :
According to your comments, you are 2 1/2 months after surgery.  You have had cartilage placed.  It may well be that the final result has not yet revealed itself completely.  Typically one needs to have a minimum of 3 to 4 months before you have a good sense of what the outcome is going to be and there is nothing wrong with waiting even longer.  Your nose has to have a totally normal feel to it, no numbness or stiffness, and the surgeon has to determine by feel and inspection that healing is basically complete.  Taping your nose is not likely to help.  It is certainly not a bad idea to “ask my surgeon to rise the columella graft and forget alar retraction.”  
  
If you do not want to go for another surgery, I think you are going to have to wait until everything does mature and then consider non-surgical revision rhinoplasty, either temporary or permanent.  That is the most important thing; you need to know your options.  
  
If you want a second opinion, consult with a surgeon who is highly specialized in revision rhinoplasty, both surgical and non-surgical, and consider temporary versus permanent if you are opting for non-surgical.  I do not know if that is going to be appropriate, obviously, without the benefit of inspection.  The majority are going to go for a second opinion and third opinion.  Be sure to bring a friend or family member with you.  Takes notes and submit questions ahead of time.  
  
Be sure to examine the prospective surgeon’s website and look for a huge gallery of before and after photos.  You want to make sure the results are natural and consistent with what you consider to be satisfactory.  Check out the section on the website that has the computer imaging demonstrated showing the before, the predicted after on the computer, and the actual after.  This is very important, so you can see how well computer imaging can help you decide what you would like to have done.  A consultation without computer imaging, whether it is first opinion or second opinion, is not as valuable as if you have computer imaging.  Check out the doctor’s reviews and comments by patients.  You will get the idea.  It is worth doing your homework ahead of time because if you can make a good decision this time, whether that be a non-surgical rhinoplasty or rhinoplasty, your nose history will be complete.  We do see people who have 3, 4, or 5 surgical procedures and somehow somewhere along the line some bad decisions are made.  It does not take that many procedures, particularly now in the era of fillers, both permanent and non-permanent, to get satisfaction.  
  
Best wishes,
  
Robert Kotler, MD, FACS

William Portuese, MD · Answer

The treatment for alar retraction is to use a composite graft harvested from the ear, which is composed of both skin and cartilage. The treatment for a hanging columella is a columella plasty, which involves trimming back excess cartilage and skin inside the columella. It's also important to wait for at least a year from the original surgery before embarking on another nasal tip procedure. For more information in many before-and-after examples of repairing these issues, please see the link and the video below

Alar retraction and hanging columella post-op, what are my options? (Photos)

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