Addressing alar retraction and hanging columella 4 years after revision rhinoseptoplasty (photo)

Question

I am 4+ years post-op from revision rhinoseptoplasty to correct functional issues and cosmetic deformities due to shrink-wrapping. I was unhappy with my nose for a long time because of extreme swelling post-revision. At this point, I am content with everything aside from the alar retraction and hanging columella (which were a problem after primary). I’d like to avoid tertiary surgery given the risks. Is it possible to place alar rim grafts and trim the columella in office under local anesthesia?

Gianfranco Frojo, MD · Answer

This is quite a nice result for a revisionary surgery and I would personally not mess with this outcome. Operating on a nose for the 3rd time will lead to even more swelling, more scarring, and more potential unpredictability.

Eric M. Joseph, MD · Answer

Microdroplet Silikon-1000 nasal injections are an excellent alternative to revision rhinoplasty surgery, when somebody has nostril retraction. This would not help in lifting your columella, however, you could achieve nostril lowering on front view, and I think you might find that attractive. I hope this helps, and thank you for this question. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Generally speaking the best way to address alar retraction is with placement of extended alar contour grafts. Usually this entails full release of scar tissue with mobility of the ala and tip complex during a revision.. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

You mostly have a hanging columella, and only minimal Alar retraction. You might just consider performing a columella-plasty which can be done under local anesthesia in an office based surgery center. The numbing shots will be quite painful in the entire columella and tip, so most patients undergo this under a brief general anesthesia for patient safety, and comfort.

Addressing alar retraction and hanging columella 4 years after revision rhinoseptoplasty (photo)

Answers (4)

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