Columellar Fullness and Too Low Strut Graft After Rhinoplasty

I had open Rhinoplasty 4 weeks ago and so far have poor results. My concerns are that the columella is so full and the strut graft appears to be attached too low inferiorly. I also have a crease above my upper lip when I try to smile (because the skin where the strut is is so immobile) and on lateral view when I smile there are 2 very large bulges that form under each nostril. Will this eventually go away with time? Will the columellar fullness decrease or is it the strut making it full?

Doctor Answers 9

4 weeks after nose job is too early to judge; wait 6 months

It is far too early to draw any conclusions about the final appearance of your nose.

The fullness of the columella and the crease above your upper lip are likely due to swelling and very likely to resolve as time passes.

Give your nose a good six months from surgery prior to judging the long term results

Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Columellar Struts

You ask all the right questions. The answers will be obvious after the swelling resolves. Fullness at the base of the nose is always present 4 weeks post-op when you have an open rhinoplasty with strut placement.

If this is swelling, it will resolve over the next few months; if not, the strut can be repositioned.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

One month after rhinoplasty is too early to get worried

One month after rhinoplasty is too early to get worried. It can take several months for the tissues to settle and the swelling to resolve. If you post a picture, we may be able to give you more specific advice. The best thing would be to discuss these issues with your surgeon. Good luck with your recovery.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Open rhinoplasty results at 4 weeks

The crease under the nose and the swelling should resolve with time. These are the effects of swelling. The appearance of the columella will improve with time, and I advise patience. The results of open rhinoplasty will take months to become manifest.

Maurice M. Khosh, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

The Columella Question.

One month after Rhinoplasty, you're still very swollen, so your final result is not yet visible.

Your best source of information is your surgeon when it comes to the appearance of your columella.

Feel free to post / email me photos, and I'll be happy to give you my thoughts.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

The columella always reduces some with time

The columella as well as the tip area is the most dependent area of the nose and usually the areas with the most thickness, so it always takes more time for the swelling to go down. If a cartilage graft is placed the skin has to shink down around the new cartilage structure and that could take several months.

Several factors go into the proper positioning of the columella so it is impossible to predict from your question what will happen, but if the swelling does not subside and the columella is full, it can usually be adjusted by an experienced rhinoplasty surgeon. Discuss your concerns with your surgeon you can keep track of them together. Good luck.

Dr. Miller

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 205 reviews

Rhinoplasty and columella fullness

 Columella fullness with a strut is not uncommon. But, you are only 4 weeks post-op so this may be swelling.  Give it some time, it may get better.  If a revision is necessary, you will probably have to wait a full year.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Early Rhinoplasty Concerns

As you know, healing after rhinoplasty will easily take 9 to 12 months before one can judge reliably the long-term result. After 4 weeks, you are looking at early pre-views...

If the "columellar fullness" refer to a "hanging columella", then I would predict that this concern will not resolve spontaneously. The lip changes with smiling are likely due to swelling and should improve over time.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

If you are not happy at 4 weeks, I'm afraid that's not a good sign.


Try not to worry in the short term, because it is very early, things may improve, and, in any case, nothing should be done for at least 6 months.

But (I know you don't want to hear this), in my experience, patients like you often need a revision eventually. Maybe the graft will have to be repositioned.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 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.