Notched Columella or Tip Swelling Six Weeks Post Rhinoplasty? (photos)

Question

I have a very noticeable 'step down' on my columella from sutures for my rhinoplasty 6 weeks ago. It's on both sides but much worse on my left. Is it caused by swelling in the tip anterior to the scar or poor closure? At my one month my doctor said it would dissipate but I've seen no change through the healing process. Will I need a scar revision? I have a scar on my face from the same surgery that seems thickened/uneven. Should I let my surgeon try again or Iook for someone else? Thanks!

Stephen Weber MD, FACS · Answer

Thank you for posting photos that clearly show what concerns you. I agree this is very noticeable. This can happen from time to time and should improve. It does appear that significant swelling in the tip is contributing. In the past, I have found that time, occasional steroid injections and lastly dermabrasion can be very helpful for this type of issue. It is very, very rare to have to revise a transcolumella scar but that can be determined during the course of further healing. Best.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

John Michael Thomassen, MD · Answer

From the photos it seems there is enough step off to warrant a scar revision.  I would not wait is it will only improve slightly and this period of waiting may add to your consternation.  It would only involve some local anesthesia in an office setting.  Otherwise you had a nice result and this minor issue can be handled by your surgeon.

John Layke, DO, FACS · Answer

Although it is fairly early in the postoperative period, you should relay your concerns to your surgeon.  Often times, the scar will generally improve over the course of a year.  If it doesn't improve, the scar can be revised to avoid the visible notching.  Best wishes!

Darryl J. Blinski, MD · Answer

I see your postop issues. You either did not fully understand open rhinoplasty's worse complication is the columella scar! or it was NOt explained t you. Seems more of us are returning to closed rhinoplasty techniques. Yes after 6 months if still a scar have revision.

Steven J. Smith, MD · Answer

It looks as though your tip is still swollen and I would expect the columellar scar to smooth out with some time. I would give at least 6 months to allow for adequate healing and resolution of the swelling.As far as the scar on your cheek, you did not mention the original cause for the scar. The scar appears to be indented and widened. Oftentimes, scars can be treated with fillers and fractional laser to help the contour and redness improve.

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Notched Columella or Tip Swelling Six Weeks Post Rhinoplasty? (photos)

Answers (8)

Answer: Notched Columella or Tip Swelling Six Weeks Post Rhinoplasty?

Answer: Notched Columella or Tip Swelling Six Weeks Post Rhinoplasty?

Answer: Postoperative rhinoplasty question

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