What Can Be Done About Long Columellar Strut After Rhinoplasty?

I had open Rhinoplasty 7 weeks ago and my tip is now overly projected and the columellar strut is too long. It extends far beyond the nasal spine and there is a clicking sensation over the nasal spine when I move my upper lip sideways. What can be done about this? Can the columella be adjusted under local anesthesia?

Doctor Answers 3

Yes this can be adjusted under local anesthesia.

 You should wait a bit longer, 3-6 months, to let the swelling go down unless your doctor feels there is no point to waiting since it is too long.

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Columella problem after Rhinoplasty

It is difficult to say without at least a picture. Rotation of the tip can cause the columella to "show" too much as viewing it from the side. The clicking sound might be a graft between the lower cartilages in the nose, used to get better tip projection. If a revision is necessary and only the tip needs to be adjusted, it is possible to do this with local and some sedation.

Sorry, I can't be more specific. I would recommend you return to see your surgeon and ask his opinion about the problem and the correction.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Overly projected strut after Rhinoplasty

At this point, only seven weeks out from surgery, the most appropriate thing to do is wait. Although it's not in our nature to exercise patience, the appearance of the nose will evolve considerably over the next several months. It's possible that scar tissue build up over the next few months could provide the strut with some stability, so that it doesn't slide over the anterior nasal spine when you move your lip.

If this problem is still persistent 6 months after surgery, revision is certainly possible. The easiest way would be to make an incision across the columella -- if you had an open rhinoplasty, it would be the same incision. Through that incision, your surgeon could visualize the strut and shorten it in the most appropriate position. Your surgeon could also place additional sutures to provide the strut with more stability. It's possible to do this under local anesthesia, but you may feel more comfortable with some sedation or general anesthesia. Ultimately, the preferences of you and your surgeon will guide the choice of anesthesia. Frequent and open communication between you and your surgeon will help guide the timing and the manner in which a revision, if needed, is performed.

Best of luck!

Sam Jejurikar, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 92 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.