After revision for a hanging columella and tip refinement, how long can I expect swelling to last? (photos)

Question

Had first open rhinoplasty 8 months ago. I need to have a revision for hanging columnella and tip refinement. How long will swelling last? Is this all I need? Thank you

Thomas A. Mustoe, MD, FACS · Answer

Overall the shape of your nose is fine other than the hanging columella, but would benefit from tip refinement.   Swelling after revision takes at least as long to resolve as a primary rhinoplasty.  You have relatively thick skin which is contributing to the lack of definition of the tip, and swelling is as well.  Precise dissection with meticulous removal of scar tissue, and monthly steroid injections usually yields improvement and resolution of most of the swelling within 3 months, but full resolution can take longer than a year.  The best approach is preservation of most your cartilage with refinements to reshape and thorough scar removal, and some thinning of the overlying subcutaneous fatty tissue.

Steven M. Denenberg, MD · Answer

From these photos, you still have substantial cartilage in the tip, cartilage that needs to be re-positioned and re-sized to create a better-proportioned tip and nose. The operation will be more complicated, especially in the tip area, than your primary.
But swelling isn't the important thing. The important thing is what your nose looks like when the swelling has resolved.
I don't really call what you have a "hanging columella." I just call it a tip that still sits too low. The entire tip sits low, not just the columella portion of the tip.
I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. 
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, requiring skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Tanveer Janjua, MD · Answer

The swelling can easily last up to a year. Using tape and splints after surgery will help. Also avoid exercise, alcohol, sun and take arnica and bromelain to help the recovery. RegardsDr. J

Suleyman Tas, MD, FEBOPRAS · Answer

Hello, thank you for the question and provided information, photos. Most of the swelling should be resolved  with eight months. However, you are still healing phase. After all the swelling dissolve, you will see your final result. If the columella is shown more than 2-4mm, we can say that you have hanging columella. Your goals can be achieved with a well-executed rhinoplasty you can have balanced and narrower, straight nose. You need to seek an exprienced surgeon to achieve your goals.Best Regards,

William Portuese, MD · Answer

Full healing after Rhinoplasty or revision  Rhinoplasty will take one year.  Revision rhinoplasty is more difficult  than a primary rhinoplasty surgery due to fluid retention, thick skin, and scar tissue present in the tip of the nose.

Daniel Gerry, MD · Answer

Although most swelling should be resolved after 8 months, in truth the soft tissues of the nose can remain mildly swollen for as much as 12 months following a rhinoplasty.  I would agree that tip refinement might benefit your appearance if this is something you desire.  However, rhinoplasty is a very personal decision and each patient will have unique goals for the appearance of his or her nose, so it can be difficult to make blanket recommendations about what type of rhinoplasty procedure you need.  I will say that your columellar show does not seem excessive, although I don't have the benefit of making direct measurements.  Typically, 2-4 mm of show is considered aesthetically ideal, with anything significantly greater than this being considered a "hanging columella".  Just be sure you have a very clear idea of what you want to accomplish, and speak with a surgeon who will be honest with you about what is needed to achieve your specific goals. Thanks for your question!

After revision for a hanging columella and tip refinement, how long can I expect swelling to last? (photos)

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