Crooked columella. Is this the final result? (Photo)

Question

I had a rhinoplasty 30 yrs ago and 15 months ago a revision rhinoplasty. After the second one I have a hanging and crooked columella. My nostrils look asymmetrical giving my nose a crooked look. My question is that is the columella still swollen (it appears to be) or is this the final result.

Eric M. Joseph, MD · Answer

The base view of your nose is the least important since it is rarely seen during normal social activity. If you're asymmetrical nasal base is contributing to tip asymmetry on front view or oblique view,  and if this is causing you a lot of concern, another nasal tip surgery may be necessary for improving your nasal base symmetry. I hope this helps. Sincerely, Dr Joseph

Gianfranco Frojo, MD · Answer

Revision rhinoplasty patients may have swelling or asymmetry that lasts quite a long time (up to 5 years or more sometimes). I am not sure what your nose looked like prior to surgery, but I do not believe that your septum is straight nor adequately supported.  I recommend seeing a plastic surgeon with at least 6 years of integrated plastic surgery training and ideally an additional year of aesthetic surgery fellowship training.

Tanveer Janjua, MD · Answer

Columella is unlikely to go back in place. However,  you have to remind yourself that nobody looks at your nose from below. If it is not prominent when looking straight ahead then it is not worth trying to fix it. Columellar deviation can be very hard to fix. 
The nostril on one side is depressed and will need cartilage graft to lift it up. You can try a filler as well. 
Regards
Dr. J

Jacob Tower, MD · Answer

Hello, hope you are well. If your surgery took place 15 months ago, your healing process would be considered 'mature' by most standards. It would be unlikely to see further spontaneous changes in the shape of the nose or columella as a result of the healing process.
Best,Dr. Tower

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Great question. At 15 months, you could still have swelling present. I would think it would be on the more mild side. Compressions and steroid injections can provide improvement in swelling. The way to fix the columella is strong cartilage grafting material. This allows for precise suturing and anchoring of the nasal tip. By doing so, the effects of drooping and aging are significantly reduced. I would consider meeting again with your surgeon if you're comfortable to discuss more. Hope this helps!

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