How to fix retracted columella and infratip lobule? (photos)

Question

6 months post op Septorhinoplasty. I have a retracted columella due to removal of medial crural foot plates and columellar retraction stitch (that I did not ask for, I loved my collumella), flat tip, and my infratip lobule is gone and tip is much shorter. I have seen a couple revision surgeons and I understand that I need rib graft to extend columella. I’m not sure what the procedure would be to reconstruct my infratip lobule, and essentially look as close to what I looked like pre-op.

Umang Mehta, MD · Answer

Thanks for the question and photos. Sorry to hear you had a negative outcome from your rhinoplasty... It would be worth bringing up your concerns with your primary surgeon, but it's also very wise that you are doing due diligence in seeing revision rhinoplasty specialists. An in-person examination would be ideal to determine how much septum you have left, at the front and back. A caudal septal extension graft would almost certainly be needed. This can be comprised of septal, rib, or donor rib cartilage. Ear cartilage is a possibility, though generally not as sturdy as the other cartilage sources. The infratip can be lengthened with this same graft, as it pushes the medial crura of the lower lateral cartilages back down. A shield graft made of cartilage +/- a soft tissue graft can also be used to lengthen the infratip and give the tip a more aesthetically pleasing shape. Your bridge could be smoothed out as well, if this is of interest to you. Another option for you could be filler to lengthen the columella/infratip, though this has to be performed very carefully and judiciously by an expert in nonsurgical rhinoplasty, as the blood supply to the skin can be affected, especially in someone who has had prior surgery. Filler in the nose can last for at least a year and sometimes 3+ years. Computer imaging during the consultation can help you determine the best course of action for your concerns.  Kind regards,Dr. Mehta

Sam Naficy, MD, FACS · Answer

This could be addressed with cartilage grafting, ideally ear cartilage to the columella and infratip.  Can also do a septal extension graft but that is more complicated an may require rib cartilage.  Either way wait till you ~ 1 year from your last surgery.

William Portuese, MD · Answer

It is best to wait 1 year after the primary surgery before any revision.  Also important to know how much cartilage is left over on the inside of the nose for grafting purposes.  This will determine where the graft comes from.  There is still a cartilage dorsal hump present which can be removed and used to augment /restore the columella

Richard W. Fleming, MD (retired) · Answer

Cartilage grafts will be necessary to augment the retracted columella and infra-tip lobule as I'm sure you've been told during your revision consultations. However, I would probably recommend using ear cartilage rather than harvesting from the rib which I find is rarely necessary.

How to fix retracted columella and infratip lobule? (photos)

Answers (4)

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