Protrusion from Columella into One Nostril After Rhinoplasty

Question

I had open rhinoplasty 19 days ago - septoplasty, smr turbinectomy, cartilage supports to improve valves, and shaping of the end of long/hooked nose. The swelling's gone down a lot, nose shape looks good BUT within a few days of removing outer splint and internal splints at upper edge of nostrils, cartilage or something alongside the columella on one side has moved out and formed from top to bottom at the front of the nostril into a long red bony or cartilage "flap" protruding across the front of the nostril and makes the nostril look partially closed. What has gone wrong and what can be done about it?

Richard W. Westreich, MD · Answer

In my opinion, 99.99 times out of 100, nostril asymmetry is from the caudal septum. Yours probably needs to be trimmed back since it is too long for the new shape of your nose. Usually that can be done, unless a large resection of septal cartilage was done in the original operation. 1 cm of undisturbed cartilage needs to be present in that area in order to ensure support for the rest of your nose.
If that is the problem and you have enough cartilage, then it is a minor procedure compared to the original operation.
Good luck

C. Spencer Cochran, MD · Answer

From the appearance of the photograph, it looks as if your caudal septum (the lowest portion) is displaced into the nostril.  This can be reduced and trimmed to correct the problem.

William Portuese, MD · Answer

Based on the description provided, this appears to be swelling along the incision line on the left side.  Most rhinoplasty surgeons make the septoplasty incision on the left side.  Whichever incision was performed on the side harvesting septal cartilage will be more swollen.  Occasionally where the sutures were placed on the columella, this can be pulled apart on a temporary basis and will resolve over time.  It tends to be more swollen on one side versus the other.  This will most likely settle down on its own in the next two weeks.

Protrusion from Columella into One Nostril After Rhinoplasty

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Protrusion from Columella into One Nostril After Rhinoplasty

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