Can nasal spine grafts and columella grafts permanently affect the smile? If so, can they be removed to reverse? (Photo)

Question

I recently had a revision in which extensive grafting was done at base all around the columella including the sides & below, and the columella as well to create the look I had prior to my original surgery. First it seems way too much in general but second I am three weeks post op and my smile is very bad. I am not terribly swollen but when I smile it seems as the lip is prohibited from going up over the grafts. Can this be permanent? This is the exact opposite of what was supposed to occur.

Tanveer Janjua, MD · Answer

Smile change after rhinoplasty is a temporary issue as the muscles in the upper lip especially in the midline get back to normal over a few months. However, in some cases it can be a permanent change as well. This is the tradeoff for improving the columella and the base of nasal spine. Removing the grafts is not a good idea. Also, 3 weeks post op is way too early to even think about any intervention. Give it time. RegardsDr. Janjua

Andrew Miller, MD · Answer

It is still too early to judge the smile or think about taking some grafting out. Give it at least 3 months and then revisit the situation with your surgeon. It should improve some by then.

Matthew Bridges, MD, FACS · Answer

This can happen when rigid structural grafts are used in rhinoplasty.  Although this can be exacerbated by swelling, those may need to be adjusted surgically.  The good news is that it frequently can be adjusted with a minor surgery, sometimes with local anesthesia.  Discuss with your surgeon and if you are not satisfied, get another opinion.

Steven Wallach, MD · Answer

Lip movement may be affected by the grafts, but more likely by swelling initially after surgery.  It is too early to consider the graft issue as a possibility, because you have to allow for the swelling to subside.

Richard Clark, MD · Answer

I am saddened that you have had at least two surgeries and you are having this problem. If your surgeon was attempting to open your lip/nose junction [Naso-Labial junction] to make your nose more like your original appearance than he may have overcorrected it on purpose and it may be significantly better in another month. If the situation does not significantly improve, you can lobby to have some of the graft or implant material at the junction removed to allow for a longer lip and a higher Naso-Labial junction and a less turned up nose. As it looks in the pictures, there is a very short upper lip before the nose takes over and this is because your columella is very much too low [the Naso-Labial junction where the lip converts into nose is too low on the lip]. Anytime a surgeon does open rhinoplasty there will be a scar on the columella which may be fine yet may be noticeably wide and even notched and malpositioned. So, even though the doctor may feel he or she can achieve a better overall rhinoplasty in their hands by doing open rhinoplasty, the beauty of the columella is relatively disrespected and perhaps is considered less important than other aspects of the nose. If the columella can be scarred with impunity, are the other elements of a beautiful columella also not high priorities? The other elements of a beautiful columella include: 1) the columella should break away from the upper lip at a natural ratio of lip length to nose length; 2) the columella should have an elegant double reverse curve; 3) the columella should not hang with excessive nostril show from the side; 4) the columella should not be too starkly turned up with a Naso-Labial angle over 110 degrees. Of course, an excellent rhinoplasty surgeon will keep these things in mind whether the procedure is done open or closed. The answer as to if the grafts will change your smile long term is uncertain, but I can tell you that usually when cartilage is used to augment the naso-labial junction area the smile returns to normal. When that Naso-Labial junction is very retracted and the angle between the lip and columella is quite acute even a bone graft will usually not permanently impact the smile. I have at least one patient after bone grafting that area who had a permanent slight change with a broad smile, but the improvement [according to the patient] of her very acute Naso-Labial angle was very much worth the minimal change of the smile...I can’t say that you will have that experience.

Can nasal spine grafts and columella grafts permanently affect the smile? If so, can they be removed to reverse? (Photo)

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