Columnella retraction and slightly droopy tip after rhinoplasty - will I need a revision? (Photos)

Hello. Thank you for the clear description and photos. What you describe fits two issues that can appear together. The columella looks a bit retracted and the tip descends when you smile. Without an in person exam any plan is provisional. The outline below can help frame next steps.
What is likely going on• Columella retraction often reflects how the caudal septum and medial crura were set. If support is short or scar tethering pulls upward the profile can look flat• Tip descent on smiling is commonly a mix of limited structural support and the action of the depressor septi nasi. When support is rebuilt the smile related dip usually improves
Will time fix it• Small refinements can still happen between months 11 and 18• A meaningful change in columella length or smile stability is unlikely without targeted treatment
Nonsurgical options while you decide• Very conservative hyaluronic acid micro droplets at the columella base or infratip can soften the impression of retraction. This is camouflage not a structural fix. The area is vascular so safety protocols are essential• A temporary trial that reduces depressor septi pull can show whether controlling that muscle improves smile dynamics. This helps decision making for a structural plan
When a revision makes sense• If after month 12 the shape is stable and the contour still bothers you a focused revision can address structure and motion together
What a revision usually involves for this pattern• Rebuild tip support with a columellar strut or a septal extension graft to set projection and rotation with better stability• Use tongue in groove to refine the alar columellar relationship and reduce the retracted look• Release scar bands that tether the columella or infratip• If the lateral walls look narrow or soft add small alar batten or rim grafts for balance• Improve smile stability by restoring support. Some surgeons also address the depressor septi in the same session• If septal cartilage is limited plan on ear or rib cartilage. Rib is chosen when more strength and length are required
Expectations and timeline• Swelling over the tip and columella is common for several months• Most patients see a new baseline by month 6 with further refinement to one year
Smart questions for your consultation• Which element is primary in your case. Support deficiency, scar tether, muscle pull• Will a columellar strut or a septal extension be used and why• How will the alar columellar relationship be managed. Will tongue in groove be used• Which cartilage source is anticipated• How will smile dynamics be evaluated and addressed• Will the internal nasal valve need support at the same time
If you would like a case specific view standardized front oblique and smiling photos plus a brief operative summary allow a tailored plan before any medical evaluation. Coordinators can help collect these details through a short complimentary conversation.
Wishing you calm decision making and a result that feels balanced at rest and on smile.Güray Yeşiladalı, MD