Are the Problems with my Columella Going to Subside? Or Are Any of These Revisional Issues (photo)

Question

I loved my nose before but due to an injury I sustained which left me with a hump and breathing issues. refinement for the bulblous tip, hump reduction and minimal rotation to offset the reduction in tip was recommended. Immediately after surgery I noticed a piece of skin was hanging unsutured. Dr acknowledged Columella has indentations on each side. it also looks like there's a step in the columella, top portion sits lower. Nse is pointing down almost hook like.

John Alexander II, MD · Answer

One of the main problems I see with open rhinoplasty is the visible columellar scar. Although your scar will improve with time, it will need revising. Usually it is prudent to wait a few months before doing so, but in your case the step off is significant enough that I would consider doing it earlier. This can be avoided if the incision is carefully closed. I prefer closed rhinoplasty because it avoids this scar. Most people don't do closed rhinoplasty because they just don't see it in their training anymore, so they aren't comfortable with it.

Kenneth Hughes, MD · Answer

The nose can be swollen for up to a year or more.  Swelling will depend upon the nature of maneuvers employed, presence of grafts or implants, thickness of skin, open vs closed, revision vs primary,  etc.	Kenneth Hughes, MD	Los Angeles, CA

Toby Mayer, MD · Answer

Revision of columellar scar for a step off can be done under local anesthesia in the office. It is unlikely that this will improve with time so it can be revised now unless there are other issues with your nose.

Jason Altman, MD · Answer

The most important factor here is time.  When deciding when and if revisional surgery is needed, we need to know how long ago the surgery was.  

	Looking at your pictures, it seems that the scar is still "fresh" and fairly new.  In my experience this tends to improve dramatically with time.  I usually advise patients to wait at least 6 months and preferably 12 before attempting any revisions on a nose.

	
	That being said, if you are unhappy at that time, these appear to be very minor issues that can be touched up!

James Bonaparte, MD, MSc, FRCSC · Answer

Hi there,

	I took a look at the photos and I get the impression its relatively early since your surgery? Just curious how long ago you had the procedure. I'll give you my advice and opinion based on my assumption that  it was within 6 months. 

	First off, you had an open rhinoplasty (hence the incision in the columella) and thus the surgeon needed to create what is called a "flap." This is basically skin that is peeled off your nose. Before the surgery some of the blood and "fluid" that was normally in your skin would just drain with gravity through normal channels down the columella into your upper lip and then follow the normal route into your neck. That is how our lymphatic drainage system and venous systems work. After surgery, that has been disrupted. Now as the fluid/blood tries to drain down the columella, it has nowhere to go and gets stuck and you end up with Edema. Its the same situation when you stand for a looooongg time and you notice little indentations in your your legs from socks. Thats basically edema that just needs time to get reabsorbed. Unfortunately in your columella, it has nowhere to go early on and gets backed up and really puffy like you see. It almost looks like a stair-step. But think about it, the top part (near the tip of your nose) is swollen and the bottom part (closest to your lip) is not, exactly what you would expect in this situation. It can obviously be distressing when it happens but let me reassure you. The VAST majority of times this goes away. The suturing job looks good to me thus i doubt it is related. 

	As your body heals new lymph channels form and thus eventually the edema will drain. In all fairness, i tell my patients in can take up to 1 year in rare cases. 

	Regardless, worst case scenario it doesn't go away. There are options. You can treat it with lasers, do a scar revision, etc. A scar revision would be easy to do if required. I would really try not to worry too much about it as i truly believe you will have a great result in the end. 

	Keep in touch with your primary surgeon and I'm sure they will guide you through the process.

Shervin Naderi, MD, FACS · Answer

Hi

	Your question is about the columellar open rhinoplasty scar.  It looks depressed which results from inadequate tissue eversion during closure.  Better suturing of the incision at the time of the rhinoplasty would have prevented this from happening. Fortunately all scars usually improve with time.  If this is the only issue, you wont need an actual revision rhinoplasty but you may require scar revision.  Talk to your surgeon and see if he is OK with you using Silicone topical creams.  Give it time - over a year or longer.  Dont rush into another surgery.

Are the Problems with my Columella Going to Subside? Or Are Any of These Revisional Issues (photo)

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