Retracted columella after car accident - how to fix it? (photos)

Question

Hello, I need help with my columella, I was in a car accident and lost some tip support. From my understanding and research I now have a retracted columella. The bones were fractured leaving me with a deviated septum that has yet to be fixed. The tip of my nose was poorly stitched back on to my columella. It’s lopsided due to a small chunk missing and not being completely stitched sealed.

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a rhinoplasty and/or nasal reconstruction covered by insurance.  A nasal tip reconstruction or a tip rhinoplasty can be performed to improve the nasal tip support and overall symmetry as mentioned in your question.  The modification of your nasal cartilage can be done with trimming, stitching or grafting.  If your septum is deviated as mentioned, and you have breathing difficulty, a septoplasty may benefit you as well.  Your septal cartilage will likely be available for reconstruction (or rhinoplasty), but I would also be sure to have MTF (cadaver) cartilage on hand in case your septum is too deviated to harvest for cartilage graft support.

The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in men who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Mark G. Albert, MD, FACS · Answer

Hello,
Thank you for your question. It looks like you would benefit from a cartilage graft, which can be taken from your septum at the same time as your septoplasty. Both procedures would likely be covered by insurance and they can be done using the closed / scarless approach. The "lopsidedness" should be correctable as well.
Mark G. Albert, M.D., F.A.C.S.New York, NY and Boston, MA

Tanveer Janjua, MD · Answer

It needs a multi step approach. First needs a cartilage graft and a few months later opening up of the incision and improving the incision line by better stitching. 
It is not an easy task and has to be handled carefully with patience and time.
Regards
Dr. J

Zoran Potparic, MD · Answer

There is no doubt that you can expect significant improvement after appropriate reconstruction of the nose and septum. Only on the basis of in person consultation and evaluation of functional and aesthetic  aspect of your deformity, a board certified plastic or ENT surgeon with expertise in nose surgery, can come with a comprehensive plan of treatment. Good luck.

Richard Mark Winters, MD · Answer

You have injured both the columellar skin and the underlying medial crus of your lower lateral cartilages in the setting of inherently poor tip support

In order to fix your deformity, it seems you would likely need structural support for the caudal structures which would likely take the form of septal extension grafting or columellar strut grafting

Good luck

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

Thank you for your questions and for sharing your photographs.
You would require having a Septorhinoplasty (Septoplasty + Rhinoplasty) to correct the deformity. 
Cartilage graft will be required to be harvested from your nasal septum. However, if the damage to your septal cartilage is extensive an alternative source for harvesting the graft must be considered.
I would suggest that you consult with a nasal surgeon (Rhinologist) with expertise in performing complex rhinoplasty. You should expect a full detailed examination of your nose is required to assess your nasal skin, cartilage, bony structures, and your nasal airway/ breathing. 
Best wishes,

Retracted columella after car accident - how to fix it? (photos)

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