Revision Rhinoplasty for Too Low Columellar Strut?

I had open Rhinoplasty 7 weeks ago and I am concerned about the columellar strut. I can feel the distinct ridge of the strut extending far into my upper lip. Also, when I try to smile, the strut ridge becomes visible and a fold forms under the base of the strut. I feel that the strut extends too far into the upper lip area (far beyond the columellar base). Will this get better with time? Does this commonly happen? If I require revision, can this be done in the office under local anesthesia?

Doctor Answers 6

Don't do anything too quickly.

While it's possible that the strut extends too far, it is indeed too early in the post-op period to make any final judgments.

Even if a strut is too long, it's usually best to let the wound mature (heal) some more before shortening the graft. This avoids further aggravating an already inflamed area, but it also allows some of the structural support to "set," so to speak. If necessary--let's say after 3 to 6 months--a columellar strut can often be shortened or modified through a sublabial incision (under the lip) or even through a tiny stab incision at the columellar base.

Good luck,


Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

The columellar strut in rhinoplasty

The stiffness of your tip and prominence of the columellar strut should soften with time. If the folding of your lip does not improve over the next several months, revision surgery would be appropriate. If the columellar strut is too long, it can be shortened pretty easily under local anesthesia. I would discuss your concerns with your surgeon to determine if in her/his opinion, shortening the columella would be a worthwhile endeavor. 

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews



You are still too fresh out of your surgery. Things will change and hopefully improve.

You have to look at the nose as a 3D structure. Did the surgeon place a large strut by accident or did he do it to build projection and support? You have to ask him/her this question. If its too long then the base can be clipped in the office but it may end up de-projecting your nose as well and that may not be what he or you want. In that case, you two have to consider other options to maintain the projection while still correcting the aesthetic problem that you are describing.

Shervin Naderi, MD, FACS
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 109 reviews

Columellar struts will soften with time

Struts commonly start out firm and immobile and can restrict movement of the nose and upper lip.  This will soften greatly with time as well as the fact th a portion of the strut will resorb over time.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Columellar Strut in Rhinoplasty Surgery

Although we always tell people to wait several months, what you're describing seems like it would be obvious. I'm not suggesting you go out and have something done immediately, but please discuss your findings with your surgeon. If a revision is necessary, it sounds like this could be done with minimal local anesthesia.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Post op open Rhinoplasty

Some important points:

1) It's too early to tell anything.

2) It's not what the nose feels like, it's what it looks like.

3) It's difficult, if not impossible, to acess the situation without knowing what was done and a clinical evaluation which is best done months after the surgery.

4) Some individuals swell tremendously while others exhibit minimal swelling, the same for the resolution of the swelling.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 14 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.