Wide/thick columella, swollen/bulbous tip, flared nostrils, nostril show in profile. How can thsi be fixed?

Question

I had an initial rhinoplasty in December 2015, and a revision in December 2016. I am having a nostril base reduction performed in April. I'm concerned with my wide, unnatural-looking columella (between nostrils). I also don't like the way my nostrils appear to flare out in the frontal view, away from the centre of my nose (vs. pointing towards the tip). Is this because of the swollen tip and columella pushing them out? Will refining the tip and reducing the width of the columella address this?

Alejandro Nogueira, MD · Answer

Do seek better opinions asap, you should NOT get alar or nostril reduction AT ALL, this will botch your nose irreversibly!!!You have a very poor nasal work in need of full revision, but never nostrils reduction (in your case); your problems:-very high tip, poor septal support, upturned tip-pinched nasal valve-no tip definition-alar rim retraction: this is the cause of the overexposure of your nostrils and the visibility of your septum, in other words... the cause of your septal exposure is NOT the excess of flare or the excess of nostrils / alae, to the contrary, it is cause by TOO SHORT and retracted alae, requiring batten caudal extension grafts to lower the alaeIf you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Nima Shemirani, MD · Answer

Dear Rhinoquestion1,I would advise against having your third surgery done five months after your revision rhinoplasty. Post-op swelling can last up to one year and even longer for revision rhinoplasty. I recommend waiting at least one year before going through with another surgery. In addition, I would recommend getting another opinion before making any other decisions. Best regards,Nima Shemirani

Brian M. Harmych, MD, FACS · Answer

Thank you for sharing your question and photographs.  In general, it takes at least 1 full year for all of the swelling to resolve after primary rhinoplasty. It takes even longer, 18–24 months, for swelling to resolve after revision rhinoplasty. In fact, the tip and nasal base takes the longest to heal. At only 3-4 months postop from revision rhinoplasty you have a lot of healing ahead of you. For this reason, you might even consider delaying the alar base reduction for a few months- consider discussing this with your surgeon. Try to remain patient and maintain close follow up with your rhinoplasty surgeon during this lengthy healing period. Good luck! Dr. Harmych

Aaron Stone, MD · Answer

Having had 2 rhinoplasties within the last 16 months and already planning your third you are headed for dangerous territory. Be very careful about having 3rd, 4th etc. rhinoplasties because the enemy of good is better and you could end up with irrepairable damage at this rate.

Donald B. Yoo, MD, FACS · Answer

Obtaining your previous operative note and consulting with a rhinoplasty specialist would be helpful. Good luck!

Wide/thick columella, swollen/bulbous tip, flared nostrils, nostril show in profile. How can thsi be fixed?

Answers (8)

Answer: Rhinoplasty revision

Answer: Rhinoplasty revision

Answer: Consult with a specialist

Answer: Consult with a specialist

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Wide/thick columella, swollen/bulbous tip, flared nostrils, nostril show in profile. How can thsi be fixed?

Answers (8)

Answer: Rhinoplasty revision

Answer: Rhinoplasty revision

Answer: Consult with a specialist

Answer: Consult with a specialist

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.