Im 6 months post primary septoplasty/rhinoplasty. I had a graft placed in my columella (presumably made from cartilage) which is still quite stiff. I am very thin skinned and most my swelling is gone. However, I still can’t smile like I used to. My lip feel obstructed by my columella and wraps around it. My depressor muscle was also cut but I don’t think it is due to this. What has gone wrong and is it fixable? How soon can I get it fixed and is it a simple revision?
May 30, 2023
Answer: Smile after rhinoplasty By your description, you likely had a caudal septal extension graft placed that can certainly impact smiling. It is indeed unlikely at this point due to the depressor septi muscle. If this is something that bothers you, discuss your options with your surgeon. Nothing went wrong with your surgery and placement of a septal extension graft is critical for nasal tip support and long-term results. A minor revision MIGHT be an option but your surgeon will know best.
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May 30, 2023
Answer: Smile after rhinoplasty By your description, you likely had a caudal septal extension graft placed that can certainly impact smiling. It is indeed unlikely at this point due to the depressor septi muscle. If this is something that bothers you, discuss your options with your surgeon. Nothing went wrong with your surgery and placement of a septal extension graft is critical for nasal tip support and long-term results. A minor revision MIGHT be an option but your surgeon will know best.
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May 31, 2023
Answer: Your smile: Your smile: after rhinoplasty even if septal work was not done and even if a Columella strut was not placed there is some stiffness of the upper lip which usually last several months. With septal work there is additional surgery at the base of the nose where the muscles connecting the tip of the nose to the lip are. with placement of columella struts there is also surgery in the area of attachment of the muscle connecting the lip to the tip of the nose. Even without deliberately cutting this muscle, called the depressor septi nasi, there is stiffness and some reduced teeth and gums show with a smile for several months after surgery. This usually comes back to normal after several months. If the depressor muscle is deliberately cut, And is cut thoroughly, meeting a segment was removed, the combination of cutting the muscle, doing septal work, and putting a columela graft, can all contribute to more dramatic stiffness and more prolonged stiffness of the upper lip. If the muscle was thoroughly cut there may be some small permanent change. Based on the photos you show it looks like there is only a millimeter or two reduction of teeth and gum show at the six month mark. This may improve further over the next several months, but there could be a very minor reduction of lip mobility on smiling that persists.
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May 31, 2023
Answer: Your smile: Your smile: after rhinoplasty even if septal work was not done and even if a Columella strut was not placed there is some stiffness of the upper lip which usually last several months. With septal work there is additional surgery at the base of the nose where the muscles connecting the tip of the nose to the lip are. with placement of columella struts there is also surgery in the area of attachment of the muscle connecting the lip to the tip of the nose. Even without deliberately cutting this muscle, called the depressor septi nasi, there is stiffness and some reduced teeth and gums show with a smile for several months after surgery. This usually comes back to normal after several months. If the depressor muscle is deliberately cut, And is cut thoroughly, meeting a segment was removed, the combination of cutting the muscle, doing septal work, and putting a columela graft, can all contribute to more dramatic stiffness and more prolonged stiffness of the upper lip. If the muscle was thoroughly cut there may be some small permanent change. Based on the photos you show it looks like there is only a millimeter or two reduction of teeth and gum show at the six month mark. This may improve further over the next several months, but there could be a very minor reduction of lip mobility on smiling that persists.
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