6 weeks post op: columella scar not great, hangs too much and white at tip. Poor suture technique?

Question

Open septorhinoplasty 6 weeks ago. Thin skin, nose is wider now and columella shows much more now. Nose was deprojected, narrowed and the droop was fixed. Like the side profile, hate the columella scar and slope/hanging look. Never saw the columella before surgery. What happened and will it improve? Poor suture technique? Columella was not taken up enough? And white showing through? As far as I know, no grafts used. Went to experienced facial plastic surgeon San Diego

Steve Laverson, MD, FACS · Answer

In answer to your observations and sentiments:  "De-projecting" nose of course makes it appear wider, and swelling now contributes;  "Droop" was fixed by raising tip, which of course shows more columella, also accentuated by swelling;  Columella scar appears obscure in submitted photos considering you're only six weeks post-op, will continue to dissipate, and can be easily revised in future if it remains an issue.  Meanwhile, camouflage with cosmetics;  Columella "never seen" before surgery because of "droop" and over-projection;  Columella can be raised if necessary by office revision, but its bulk and immobility with smile is partly swelling and post-surgical induration.  Patience with "mother nature," will allow her to complete in her own miraculous and subtle ways the nice work of your surgeon.  Sometimes, aesthetic problems emerge after rhinoplasty that were unanticipated.  Straightforward solutions exist, but every technical maneuver with living tissue carries with it an element of unpredictability.

Ronald J. Edelson, MD · Answer

Of course you are still early in the healing process.  The columella scar will gradually fade away to the point that it will be imperceptible.  If you have a hanging columella,  this is actually quite easy to address with a minor revision after all the swelling goes down, if necessary.  A hanging columella is something I commonly see after some rhinoplasties, as some surgeons don't address it with primary rhinoplasty.   Fortunately it is quite simple to correct.

P. Daniel Ward, MD · Answer

Hi gigigirl14,Thank you for your question. At 6 weeks after rhinoplasty, all the concerns that you describe could all be part of the normal healing process. I encourage you to see your surgeon to discuss your concerns and to make sure that all is healing appropriately.Good luck!

Gerald Minniti, MD, FACS · Answer

Hello,Your photos are prodigious, but not helpful.  You don't appear to have worsening columellar droop, your scar is not visible, and white spot?  Maybe light reflex?  Regardless, you should go back to your surgeon, get him to take proper photos, and compare your pre op to your current, and certainly temporary, appearance.Best of luck!

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for enquire.It's too early to make value judgments with only 6 weeks after a rhinoplasty.Swelling after a rhinoplasty depends of the surgery complexity.In this regard, the nasal swelling Post-op It can last from two weeks to two months.To reduce this swelling, I recommend you perform delicates daily lymphatic drainage massage therapy over the face (around the nose) avoid sun exposure, and take pain/inflamation pills, as your surgeron precribe you.Kind regards, Dr. Emmanuel Mallol Cotes.-

Bianca Knoll, MD · Answer

Dear gigigirl, first congratulations to your rhinoplasty. It looks very nice. Having had an open rhinoplasty you really have to be patient. It really takes time for the swelling to resolve. 6 weeks are no time. Think about it, the nasal tip and the columella are the lowest points, and therefore the swelling will take longest to resolve in that area. Be patient, and hang in there. Best wishes

Susan Kaweski, MD · Answer

You need to give your nose more time to heal. The scars take 1-2 years to settle. The swelling postoperatively will also settle around the same time. Be patient.

Victor Chung, MD · Answer

At 6 weeks after a rhinoplasty surgery, your nose is still in the earliest stages of healing.Swelling is just starting to go down. And scars have not started to fade. At 6 weeks, I'm seeing my patients to monitor their healing progress and to encourage good habits. I do not evaluate the nose for the final outcome, because the nose is so far from it. As surgeons, we know you're excited to see the end result. We are excited too, but we do ask for your patience. The most important thing you can be doing now is keeping your follow-up appointments with your surgeon. Definitely, voice your concerns, but do not be discouraged when your surgeon says you need to keep waiting. We are waiting with you.

Arian Mowlavi, MD, FACS (license on probation) · Answer

From your photos, I feel that you have had a great result; nasal tip position is significantly improved. Please be patient at this point and do not consider revision surgery.

6 weeks post op: columella scar not great, hangs too much and white at tip. Poor suture technique?

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