Crease above smile and longer upper lip after open rhinoplasty - How would I fix this during a revision rhinoplasty? (Photo)

Question

I also have a huge hump which appears bigger now and higher nostrils at 3/4 view because the tip angle was pushed up. If shortening the tip caused the upper lip lengthening, would a graft to the septum help? No grafts used in my surgery and no septi depressor release. Surgeon couldn't help - here are his notes: "Dorsal reduction, cephalic trim of lower lateral cartilages, intradermal suture, medial and lateral osteotomies..."

Mohsen Tavoussi, MD, DO · Answer

The upper lip crease can be corrected by releasing the muscle that us responsible for this problem. As far as your nose is concerned, frontal and profile pictures are needed. Best

William Portuese, MD · Answer

A full set of facial photographs of the nose are required to make a determination about how to proceed with a very difficult surgical procedure.  Revision rhinoplasty and more difficult than a primary rhinoplasty due to the fact that there is been previous ulcerations to the normal anatomy, and scar tissue present.  A revision rhinoplasty will not help the upper lip.  Releasing the depressor septi ligament will prevent the tip of the nose from drooping downward when smiling.

Edward Farrior, MD · Answer

The management would depend on a number of things. First question is how far post op are you. If it is acute, within the first 3 months after surgery, i would give it a full 6 months to improve. If you are beyond 6 months then Botox can soften the activity of the muscle at the base of the columella and reduce the folding while you allow more time to heal. If you are beyond a year post op you may need surgery to reduce the amount of tissue at the base of the columella. this could be the natural septum or it could be the result of a columellar strut of caudal septal extension graft.

Crease above smile and longer upper lip after open rhinoplasty - How would I fix this during a revision rhinoplasty? (Photo)

Answers (3)

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