New swollen/droopy columella 2 years s/p rhinoplasty (Photo)

Hello daisies900,
This is a great question and I'm glad you're seeing your surgeon next week. Oftentimes we use different columellar and septal grafts to change the rotation of the tip and prevent the columella from hanging or drooping. These can vary from columellar strut grafts to septal extension grafts, tongue-in-groove, plumping grafts, etc. It is possible that a graft is resorbed or there is loss of some of the tip support mechanisms. As the rotation changes with the tip drooping down, you will lose some of that slope you used to have. I would definitely bring it up to your surgeon and show him/her the exact photos you posted on here. I always appreciate when my patients are completely open with me about their results. Besides, your surgeon is going to know exactly what graft they put in there and how to possibly fix it. If they are not helpful, I would just make sure to ask for the operative report so that any surgeon you see for a second opinion can come up with an accurate plan to address your concerns.
I hope that helps! Good luck!
Daniel Tran, MDFacial Plastic SurgeonWashington, DC

To make an assessment regarding the outcome of any plastic surgery procedure, we need to see proper before and after pictures.
We need standardized pictures, taken at the same distance with the same angles in order to make a quality assessment.
Taking pictures from different angles, changes the appearance of the noseWe also typically do not make assessments of faces in a dynamic state with contraction of muscles of facial expression.
The impact the contracting muscles of facial expression has cannot really be anticipated or treated during surgical procedure.
The impact on your nose, while smiling is not treatable with surgery
Follow up with your provider. Ask them to show you standard before and after pictures and use those when making an assessment and discussing your outcome.
I don’t think there’s much plastic surgeons are going to do about concerns about what your face or nose looks like when you contract, your facial muscles.
Best,
Mats Hagstrom, MD