Too much upturned nose after rhinoplasty with columella shows too much (Photo)

Question

Had surgery 5 days ago. I didn't want upturn at all. Never had splint after surgery. How much the tip will drop? Will the columella still show excessively hanging and fat after the swollen goes away? How complicated is it to have a revision to fix the columella?

David Gilpin, MD · Answer

Thank you for your question.  This is a common concern and worry for many patients after having a rhinoplasty.  Remember that at 5 days post-surgery, you are still very swollen, and this will "pull" the tip upwards.  Also, you had an incision in the columella, and this will be swollen as well.  It will take weeks, and in reality months, for this to completely resolve. If you have any other concerns, be sure to discuss this with your surgeon.  I hope that this helps!-David Gilpin

Jerold Olson, MD · Answer

Hello,It is normal to be concerned about the appearance of the nose following rhinoplasty. Changing the appearance of your face is a big step. However, as the other surgeons have commented it is much too early to be concerned about the need for revision surgery.There will be dramatic changes in the appearance of your nose over the next several weeks. Good luck.

John Layke, DO, FACS · Answer

It is FAR too early to assess your final results, as your nose will continue to change for weeks to months.  It is extremely common for the nose to have an "upturned" or overrotated tip, that will slowly settle over the first 4-6 weeks.  Relay your concerns to your surgeon who will  create a timeline of events to expect certain results.  Best wishes!

Sirius K. Yoo, MD · Answer

Thank you for your question.  This is a common concern immediately after rhinoplasty.  The tape and swelling hold the nose up (rotated) much more than it will end up as.  While I can't tell you how much it is going to swing back down, because I can't tell how much the tape is holding the nose up, I can tell you that your photos do not look out of the ordinary at all.  Your columella will also narrow as the swelling goes down.  Don't worry about revision at this point.  Try to rest, relax and heal from your primary surgery.  Its way, way to early to make any assessment about the results.  All the best!

Vincent N. Zubowicz, MD · Answer

It's much too early to make any pronouncement about the rhinoplasty. You have a sizable amount of swelling that goes along with procedure and there will be fundamental changes over the course of convalescence that will take many weeks if not months.

R. Stephen Mulholland, MD (retired) · Answer

Dear nancy111,

Thank you for your clinical post and photograph.  Five days after a rhinoplasty surgery where
there was just the tip that was operated on or there was bridge work as well as
tip is far too early to assess the aesthetic outcome.  Whether it was external rhinoplasty or
internal rhinoplasty you had alar base reductions and tip work was
performed.  This will result in a
tremendous amount of swelling of the columella and the tip.  The tip often appears over projected and this
will settle in the ensuing weeks and months following your surgery.  I would try not to be concerned at this
point.  Hopefully you have allotted 1-2
weeks prior to returning to work.  You
will always need to use some type of excuse such as minor nasal trauma your nose
was hit by a softball or some other such excuse that you can use to explain why
your nasal tip is swollen. After 4-6
weeks the nasal tip will drop and by 4-6 months you’ll have a much better sense
of the actual tip projection and rotation. I would follow-up closely with your certified rhinoplasty
surgeon as they are in the best position to advise you as to the normal
post-operative course of healing and structure, form and shape of your emerging
nose.

I always reassure patients that their nose will look horrific
in the first week and they will graduate to looking somewhat scary by the end
of the second week, swelling often has reduced the nasal tip subtly takes many
months to reveal itself.  Reduction of
the nasal bridge bumps usually looks good by 3-6 weeks, but nasal tip subtly
including tip rotation and projection will not be finalized until one
year.  I would not concern yourself with
tip revision surgery at this point as most of your concerns, if not all of them,
will resolve with time.

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

Alex N. Mesbahi, MD - Account Suspended · Answer

Generally, the tip will drop at least 2 mm over time, especially with open rhinoplasty.  This may depend on the techniques used such as cartilage grafting.  5 days is very early to judge the outcome and the tip will certainly drop as the swelling begins to resolve.  Discuss your concerns with your surgeon and I am sure you will be reassured.

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