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!

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.

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

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.

Remus Repta, MD · Answer

Thank you for the question and the photos.  It does look like swelling is a big part of the step-off that you are referring to.  I would definitely give it plenty of time as I suspect that as time goes by and swelling subsides you will see an improvement in that area.All the best,Dr. Remus Repta

Brian J. Reagan, MD · Answer

It is too early to comment on the need for scar revision.  Your tip is still swollen, which enhances the step off.  Consider massage with a silicone based cream.  Be patient. All the Best.

R. Stephen Mulholland, MD (retired) · Answer

Dear Isabelle50,

Thank you for your clinical photographs and it does appear
you have a step off at the junction between the scar and the soft tissue of the
columella under the scar.  This can be
relatively common following significant tip reduction.  If you had a very significant tip projection
that required a tip reduction there will be some excess skin.  Quite commonly if the tip reduction is
modest, surgeons are reluctant to excise skin at the time of the closure as
generally over 4 to 6 months this type of pincushioning of the columella scar
will resolve.

During this period of time injections with a topical steroid
and injections with a steroid can help resolve the swelling and the edema.  Over 6 to 12 months the tip edema will settle
significantly.  This type of step
deformity with significant tip reduction, slight additional removal of tissue
above the step deformity will resolve your concerns.  The earliest that you would likely want to
entertain this would be 6 months when the scar is more pliable, soft and the
amount of tissue that needs to be removed will be less.

Occasionally, this type of step deformity completely resolves
which is conservative management and time.

I would strongly advise you to seek advice of your operative
rhinoplasty plastic surgeon as they are in the best position to understand the
maneuvers that were performed and to offer the complimentary scar revision if
necessary.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

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

Answers (8)

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