Could a Retracted Columella From Surgery 4 Months Ago Change in Appearance Over Time?

Without seeing your nose, it's hard to say if your columella would change after 4 months. It may evolve further as your nose continues to heal. It's still fairly early in the healing process, though, so I'd recommend a conservative approach and continue watching the area to see if it changes further.

Great Question.  First, I would absolutely give this some time.  You are right that you will see changes over months if not a couple of years when you are considering tip refinement.  Second, you have to trust your qualified experienced plastic surgeon.  That individual knows more about your nose at this point than anyone.

Having said that, I suspect your columella likely needs a bit more volume.  Ear cartilage works great.  Sometimes there is a bit of settling that can occur and blunt the angle between the upper lip and columella.  Plumping grafts are awesome and will likelyl support that tip in a way that the columella strut (and more likely batten graft) is more visible and effective.

Thanks for such a great question.

Dr. Hobgood.

Swelling of the nasal tip can mask some of the final result. As for a retracted columella, this can be the result of several things and may require different procedures to correct this depending upon the cause.

With an open approach the infratip lobule and bottom part of the nasal tip likely has significant edema, as this resolves it may make the columella "look" less retracted although the columella itself is unlikely to "plump" out more at this point. Depending on how much scar contracture there is, a plumping graft should help, I would give it more time before making that determination.

If you still have significant tip swelling the columellar retraction you describe may improve.  Sequential  photographs help to monitor that improvement and decide when and if a plumping graft is necessary. 

Even the slightest retraction of the collumella can leave a nasal profile slightly un-natural in appearence. Fortunately, HA filler injections can plump out this area, on if this fails, the use of an "extended" cartiledge tip graft will likely improve or eliminate this condition. Discuss these options with your surgeon. He should be able to explain these options further. Good luck and don't despair.

  No.  A retracted Columella would actually be worsened by a decreased tip rotation during the post Rhinoplasty healing phase.  While it's possible for the nasal tip to rotate downward, relaxing a bit, after a Rhinoplasty there's no mechanism that would make the nasal tip rotate upwards against gravity.  The tip rotating upwards will, on the opther hand decreased the degree of columellar retraction IMHO.