Do I Need a Revision Rhinoplasty? 2 Years Later My Columella Has Dropped. (photo)

I had a rhinoplasty done about 2 years ago to correct my broken nose and other issues with the cartilage resulting from the break healing poorly. I am happy with the bridge but the dropped columella and tip bother me. I think the surgeon made a mistake, but i went back twice already with my concern and he refuses to address it. I have recently put a call into him about a week ago and he has not called back. My nose looks normal in person but in a picture it is clearly noticeable.

Doctor Answers 7

Need for revision

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Your nasal healing should be pretty stabilized at this point. It may be worthwhile discussing with your concerns with a different surgeon if you're not happy with the response from your original doctor.

Your tip and columella should be examined and office morphing performed to discuss what changes you're actually looking for. Proper communication is vital to getting the result you want.

Revision Rhinoplasty

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From the photos, it looks like the dorsum was slightly overdone relative to the tip. Kind of a ski jump look. Some surgeons may like this, but obviously you don't and it's your nose. This really drives home the importance of preoperative photo imaging, especially for noses. The main purpose for imaging is to make sure you and the surgeon want the same thing and have the same aesthetic goals. We have a three dimensional imager in my office but either 3D or 2D will do the trick. I agree, I think you need a revision. Find someone with imaging capabilities.

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 90 reviews

Rhinoplasty revision

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It is very difficult to tell from photos what exactly bothers  you. Just  from the photo it looks like your tip is too projected, Other views would be helpful and of course an in-person exam is key.

Revision rhinoplasty for over-projected tip and hanging columella

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From the pictures you've shown, I'm guessing that very little work--if any--was done to your nasal tip at the time of your rhinoplasty. Regardless, your photos show mostly a problem with over-projection of the tip (sticking out too far) and a smaller problem with the columellar hang. Of course, the tip is often the trickiest part of rhinoplasty, but many techniques are available to deproject the tip and correct the columella (e.g., dome division and imbrication to deproject and a strut graft or columellar setback to fix the hanging).

Be sure to find someone who does a fair bit of revision work. You can usually get a sense of the surgeon's primary interests on his/her website. Ideally, there should be an emphasis on nasal surgery (rhinoplasty, revision rhinoplasty, and even nasal reconstruction).

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Unhappy with Tip after Rhinoplasty

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I can see what your concern is with the tip. It looks like it might be over-rotated and over-projected. This can be fixed with a revision rhinoplasty. You can also send your pics through my website for imaging.

Tip unlikely to change 2 years after rhino

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I agree w/ Dr. Fleming.  2 years is more than sufficient time for swelling, etc. to resolve.  At this point in the post-operative period, I feel you should probably discuss a revision.  I would try and contact your surgeon again and give him/her one last shot at trying to see if they are comfortable and willing to revise your nose.  If you do not feel comfortable, seek out another opinion.

Dissatisfied with Tip 2 Years Post Rhinoplasty

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As you know, your tip will not change 2 years post rhinoplasty - you have been very patient, but it is time to consider a revision. Your tip can be reduced and refined, and your hanging columella corrected. If your surgeon does not want to work with you, consult with a surgeon who specializes in revision rhinoplasty. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 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.