Open Rhinoplasty Incision Location?

I had an open rhinoplasty two weeks ago to correct an overly bulbous and droopy tip and I've noticed that the columella incision has been placed at the base of the columella instead of mid-columella where it's normally placed. Is there any reason why my surgeon would have done that and are there any long term side effects such as a strained upper lip associated with that? Currently I have a very stiff upper lip and I'm not sure if the location of the incision may be the reason for it.

Doctor Answers 15

Incision location

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you feel swelling I your upper lip, it is unlikely dues to the location of the open rhinoplasty incision, but rather a result of typical post op swelling.  The open rhino incision usually heals quite nicely even if it was placed slightly lower on your columella.  As time goes on, your lip will feel less stiff and the scar should be virtually invisible.

San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Columella Incision Placement During A Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Dear Sara,

Have you had a tip projection while addressing you are having a tip reduction? If so, then perhaps the incision was necessary to be made lower then the mid-columella.

Usually, the incision is made at the mid-columella - the narrowest point - as you have mentioned in your description. The stiffness of your front lip and your tip is normal at this point. 

I recommend that you communicate with your surgeon who knows the full details of your surgery.

Thank you for your inquiry and the best of wishes to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Columella incision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Narrowest point is typical.  Base is not wrong jus much less common.  I have never done that myself.  The location is unlikely to affect the upper lip motion.  For the time being that is lily due to edema.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
4.9 out of 5 stars 62 reviews

Open rhinoplasty Incision Location

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Alterations may be made to increase or decrease the nasal bridge, reduce the size or width of the nose, narrow the nostrils, change the angle between the nose and upper lip, or reshape the tip.

Sometimes a very short incision is made across the vertical strip of tissue that separates the nostrils, called the columella. This technique is called an “open rhinoplasty.” Whatever incisions are used to reshape your nose, they will ultimately be very inconspicuous.Best of luck!

Dhaval M. Patel 
Double board certified
Plastic surgeon
Hoffman Estates

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 100 reviews

Open rhinoplasty incision location

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You're right that the open rhinoplasty incision is usually placed at its narrowest point. This typically approximates the mid portion. The incision is sometimes placed a bit further down toward the lip, especially if an increase in tip projection is planned (so the incision doesn't end up too close to the tip after the tip is projected).

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Location of Open Rhinoplasty Incision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am of opinion that the most popular incision over the narrowest part of columella has the hazard of scar contracture and making it look like a deformity in many patients specially if the blood supply of the skin over the wound margins was compromised resulting into delayed healing.I therefore go for the base of columella incision and the resultant scar falls in the shadow of the nose and becomes invisible in period of time.I also vary my depth of dissection .I do not separate skin from the cartilage over the medial cruse of lower lateral cartilage with he skin so that the blood supply remains intact without compromise.I am sure not many surgeons practice this.

The location of the transcolumellar incision for an open rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The location preferred by most rhinoplasty surgeons is the narrowest part of the columella, which usually corresponds to the center. Some surgeons do prefer to have it place more posteriorly (closer to the lip). That is not to say that it's wrong, but just a variation. It would be rare to make the incision any further forward than the center point.

A strained or stiff upper lip should not be a permanent problem after rhinoplasty. Edema or swelling from such maneuvers such as making a pocket for a columellar strut or snipping the muscles that pull the nasal tip down when smiling can cause this problem. But again, it's usually temporary.

michael kim, md

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 41 reviews

Location of columellar incision in open rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is a variety of location and design of the columellar incision. the stiffness of your lip is probably not related to the location of the incision. 

An Open Rhinoplasty Incision is Placed to Give the Least Noticeable Scar

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

A mid-columellar incision is probably the most common but certainly not the only option for placing the incision. If you think about it, we decide on where to place the incision by where we think the scar will be the least noticeable. The mid-columella is the narrowest part, so placing the incision here will give you the narrowest scar. If you are planning on rotating the tip of the nose upwards however (common in many rhinoplasty's), then a mid columellar scar may become more noticeable. In these situations you will want place the scar lower on the columella so that it is more hidden. Again, placement of the incision should vary patient to patient depending on where the resulting scar will look the best. The stiff upper lip is likely related to normal swelling from the rhinoplasty, and should have nothing to do with the placement of the incision. The good news is that all columellar incision heal very well, and regardless of where it was placed, and once healed, you will likely have a scar that is not noticeable.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

Open rhinoplasty incision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Mid-columellar incision is probably the most common, although incision at the base is also an acceptable option. Base incision may actually hide the scar better than mid-columellar incision (although the scar is rarely an issue), but it creates a longer skin flap to elevate and to keep viable.  Your lip tension is not due to the incision, but lileky is due to other things that were done during the surgery, such as changes in your tip, swelling, fibrosis, possible graft placement, etc. The worst thing you can do now is to start questioning your surgeons expertise and micromanaging.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.