Upper Lip and Nose Tip Immovable After Rhinoplasty

After any surgical procedure, your body forms scar tissue for a period of 6 weeks (called the proliferative phase). During this time, your body deposits alot of collagen into the area of injury to help heal it.
Collagen acts to hold the tissues together and can create the sensation of stiffness and immobility that is common with any surgical intervention. In hand /knee surgery, we send patients to physcial/occupational therapists to help things get moving.
I would advise you to stop maniputlating your nose. Nasal surgery can be quite delicated and your frequent pulling with your hand may disrupt the stitches holding wounds together and alter the intended result.
After 6 weeks, wounds start to soften when they enter the remodeling phase.
In regards to the numbness, there are some nerves in the region of the base of the columella that enter the lip and may create some numbness. In most cases, this resolves as it sounds it has done in yours.
Hope this helps!

Stiffness of the nose and tip can occur following rhinoplasty surgery.  This phenomenon is more likely when extensive dissection is performed at the junction between the nasal cartilage and lip soft tissue.
            Although it’s impossible to know exactly what was done in your case without an operative report, it appears that both bone and cartilage were removed from the distal nose.  In addition, it appears that the depresser nasi muscles were detached.

            These maneuvers involve extensive soft tissue dissection which may be the source of your symptoms.  Under these circumstances, prolonged swelling, scarring and structural changes can result in the symptoms that you describe.  Structural changes from the use of cartilage grafts and non-absorbable sutures can cause temporary immobility of the soft tissue.  A more likely cause is scarring and prolonged swelling.

            All of these problems should resolve with the passage of time.  In some cases, resolution of lip tightness can be facilitated with gentle massage.  It’s important to realize that resolution of these problems may take up to a year following surgery.

            In the interim it’s important to be patient and maintain good communication with your plastic surgeon.  Your surgeon should be able to reassure you and alleviate your anxiety. 

Lisa,
I agree with the other surgeon's comments. I think there are several possibilities for your upper lip stiffness:
1. Weakness in the upper lip obicularis oris muscle;
2. Scar tissue adhesions after removal of the depressor muscle and nasal spine;
3. A suture to secure the caudal septum to the nasal spine may have caught a bit of the upper lip soft tissue and muscle.
I would advise against trying to pull the upper lip down, but it is ok to exercise this muscle by puckering your lips. I suspect that after 6 to 8 weeks, your problem will resolve.

The stiffness of the tip of the nose and the upper lip as well as the strange sensations take about a year to go away. They always do and the tip skin will be soft and pliable then as it was before.

In general, almost all noses are numb right after a rhinoplasty. In most cases its the tip that is numb, but this numbness can extend down to the upper lip, and in rare cases some of the teeth. It is also not uncommon that one side of the nose is more numb than the other. There are nerves that are cut and stretched during a rhinoplasty, and it takes a long time for those nerves to start working again. This is true of an open as well as closed rhinoplasty, although it tends to be more extensive in open rhinoplasty. This could also be more extensive if a septoplasty is performed at the same time. This, along with the swelling, gives you a stiff, plastic type feel, and can give you an odd smile. However, the nerves will start working and again, and your nose stiffness will go away with time. This takes in most cases months, but can take years in rare cases. Extremely rarely, the numbness is permanent, although I have never seen such as case. In certain cases where an implant was used, numbness could be caused by compression against the implant, or if it happens years later, then an infected implant can cause numbness as well.Best Wishes,Pablo Prichard, MD

There are many different techniques that could have been done at the tip of the nose to make it immovable including cartilage struts and grafts. By resecting the depressor septi muscle, the upper lip movement is not affected. It only prevents the nasal tip from drooping downward when smiling. There should not be anything holding your lip inside the base of your columellar area. All of the numbness and hard, woodiness feeling in the tip usually subsides after three months postoperatively.

After rhinoplasty, the nose has prolonged swelling and stiffness. It may take two or more years all of this to subside. The numbness usually fades more quickly.
I would advise you NOT to pull on your nose, as it is actively healing. I know that it is annoying to you, but you may do some damage.
Depending on how your nose is progressing, your doctor may give you massage techniques to help soften it faster, and make it more mobile. At present however, it sounds like a normal post-rhinoplasty course.

Your description is very good and gives us a picture of what your surgeon is adjusting with your recent rhinoplasty. If the nasal spine, the bone at the very base of the nose, is prominent the upper lip appears short and the angle between the lip and the nose is very open. As the bone is trimmed the angle is reduced improving the balance between lip and nose.A suture placed at the spine will reduce the space where the bit of bone was removed and encourage the nose and lip to assume the new shape. Even a permanent suture will relax and lose its thghtness by three to four weeks.If your nose looks right don't pull on things or test the result. All will soften over time.Best of luck,Peter Johnson MD

Lisa,
Your complaints of numbness and stiffness after rhinoplasty are not uncommon. There may be many reasons for the lip tightness, ranging from a planned suturing of the lip tissues to the bone at your nasal spine, to merely a perception of tightness from the altered sensation and healing that is taking place.
Discuss this with your surgeon. He/she should be able to shed some light on the subject in your particular case. Good luck!

Stiffness and numbness are common post-operative complaints after Rhinoplasty. They usually get better with time. Just be patient, and hopefully your condition will get better soon.