Worried about columella wound and nose shape at 2 weeks post open rhinoplasty. Should I be worried or is this swelling? (photo)

Question

I had an open rhinoplasty 14 days ago, turbinate reduction and some tip restructuring. I’ve had no major problems over the last two weeks, but I have some concerns about the wound across my columella as it is very uneven and has a ‘bulge’ on the left side. This ‘bulge’ almost looks like skin that’s not flush with the rest of the wound (it’s not painful) I see my surgeon in 2 days for my first review but would also like some other opinions on this please! Should I be worried or is this swelling?

Sugitha Seneviratne, MBBS, FRACS (Plas), FACCS · Answer

The columella incision has healed with early scaring and swelling causing the asymmetry evident on the image. This may be related to the placement of the incision, post operative swelling or a combination of these two issues. My recommendation is that you work closely with your surgeon to develop a program of scar and swelling management strategies with the expectation of improvement over three to six months.

Greg Bran, MD, PhD · Answer

Thank  you for your question. According to your description and the photo the skin seems to be slightly inflamed and a stair step incision was chosen. The bulging can be caused by either asymmetric swelling of the skin or one side of the cartilage pushing against the columella (the segment of skin between your nostrils that has the scar). Discuss your concerns with your surgeon, as you are about to see him for a follow up. It might be worth considering removing the sutures, as it  will reduce the irritation of the healing skin. Overall you do not need to worry, as these are all details that can be resolved!  Good luck.

Kind regards, 
GB

Michael Elam, MD (retired) · Answer

This is a combination of poor incision placement, poor surgical technique, and overall will be an issue that you need to discuss with your surgeon. I perform open rhinoplasty procedures daily and in my over one hundred videos in my video library taken on the day of the splint removal at seven days post op the incision is barely visible. The incision should not be straight but rather a V incision or inverted V for the best results. This will likely need revision and I would suggest a secondary opinion with an expert in open rhinoplasty technique. Best regards, Michael V. Elam, M.D.

Worried about columella wound and nose shape at 2 weeks post open rhinoplasty. Should I be worried or is this swelling? (photo)

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Worried about columella wound and nose shape at 2 weeks post open rhinoplasty. Should I be worried or is this swelling? (photo)

Answers (3)

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.