Columellar strut and saddle deformity after rhinoplasty - what will happen if the depression worsens? (photo)

Question

I had an excessively aggressive septorhinoplasty in Nov that was quite sloppy. Since then, my bridge has heen depressing ever so slightly, and is eorse wjen i smile. My tip is jammed so far up that I feel like my nose will invert, and I feel pulling where the columellar strut is. I am curious what will happen if the depression worsens? Will it becime more painful/uncomfortae in the columella? Is tyere any risk of it tearing the (thin) skin?

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.It looks like your nose tip is very upturned. Your nostrils are showing too much.I recommend you a revision rhinoplasty surgery, especially if it is painful. The pain may get stronger with time.Best regards!

Randal Haworth, MD, FACS · Answer

I'm sorry to hear that you're experiencing complications after your septorhinoplasty. Based on your description and photo, it sounds like you may have developed a dorsal nasal collapse, which is a common complication of aggressive rhinoplasty surgery.

A dorsal nasal collapse occurs when there is weakening or disruption of the support structures of the nose, which can cause the bridge to depress and the tip to rotate upward. This can result in a pinched or scooped appearance to the middle part of the nose, and in severe cases, can even cause the skin to become indented or pulled inward.

If the depression worsens, it may become more uncomfortable or even painful in the columella area, especially if the columella strut has been compromised or is causing tension in the area. However, the risk of the skin tearing is low, as the skin of the nose is relatively thick and elastic.

It's important that you schedule a follow-up appointment with your surgeon to address your concerns and discuss your treatment options. In some cases, a revision rhinoplasty may be necessary to correct the dorsal nasal collapse and restore the support structures of the nose. However, this decision will depend on the extent of the collapse and the underlying causes of the complication. Your surgeon can evaluate your nose and provide a personalized treatment plan for your individual needs.

I hope this helps,
best of luck !

Eric M. Joseph, MD · Answer

I can tell by your narrative that you're concerned about the indentation above your tip getting worse. In all likelihood it will not. Depending on your examination, the indentation in between your nasal tip and your small dorsal bump may be camouflaged with microdroplet Silikon-1000 For many people this is a welcome alternative to revision rhinoplasty surgery. I hope this is helpful! Sincerely, Dr Joseph

Ronald J. Edelson, MD · Answer

You should wait a year to see the final result and then go on a few consults. I think your nose could be improved with a revision rhinoplasty. But this is a difficult area of plastic surgery so get multiple opinions

William Portuese, MD · Answer

You can Consider a revision rhinoplasty at one year after your primary rhinoplasty. It's important to make sure there's full healing before embarking on another procedure. Also important to have a copy of the operative report find out how much cartilage is left over on the inside of the nose for grafting purposes. You're going to need a cartilage graft along the lower bridge line, remove the  columellar strut and de-rotate the tip as much as possible. Choose your second rhinoplasty specialist very wisely based on extensive experience

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