Retracted Columella - thick skin Hispanic woman

Question

I am 15 months post-op from a primary rhinoplasty. The surgeon used the tongue and groove technique and my columella is extremely retracted. He is telling me he can remove the sutures and the tip will not be so high. Another surgeon told me that anyone that think my removing the sutures, the nose will drop is naive as it already healed. Another surgeon is willing to try and see what happens but says the tip may lose support. What is true? I am so confused and desperate to feel normal again!

Christian Conderman, MD · Answer

Hi!
As you may know, the tongue-in-groove technique typically involves moving the tip cartilages upwards either onto your septum or onto a central graft. Without seeing the operative report, it's difficult to say what exactly was done but given the length of time since your initial surgery, I find it to be unlikely that simply removing sutures would fully address the retracted columella. In my experience, and depending on the scarring, this would likely require the tip cartilages to be released and sutured to a caudal septal extension graft to improve the retracted columella and lead to a more harmonious alar-columellar relationship (typically 2-4 mm of columellar show). Hope that helps!

Robert Ciardullo, MD · Answer

Retracted columella and overrotated tip: The most reliable and definitive way to repair a retracted columella and over rotated tip is to take a piece of Cartilage from your septum and add it to the bottom of your septum extending the length of the nose derotating the tip and pushing the Columella down. this is called a septal caudal extension graft. This would be easiest if you have not already had part of your septum removed for other purposes. You do not show any pictures, But if your nose is short with an over rotated tip and retruded columella and if septal Cartilage is available, that would be the most effective way to deal with it.

Mats Hagstrom, MD (license on probation) · Answer

At 15 months, you are completely healed and your results are final.
To get any type of useful information do you need a quality assessment. This requires seeing a complete set of before and after pictures. If you don’t have proper before, and after pictures and ask your surgeon to forward the pictures they took.
Revision rhinoplasty, work is difficult and complex. With each operation of high-quality outcomes goes down.
Since we don’t know what the outcome of your surgery is, I can’t really give you any solid advice. At 15 months things are set and held in place with scar tissue. So removing sutures by themselves isn’t going to do anything.
You need to find a senior plastic surgeon who specializes in rhinoplasty surgery and has done thousands of cases.
This may require having quite a few consultations.
Slow down the train and start scheduling consultations. Do you all know when you’re in the hands of someone who knows what they’re doing.
To start with, they should be able to give you examples of previous patients who have similar characteristics to your own. An experience plastic surgeon should have hundreds or thousands of before and after pictures to choose from and help have a good assessment and understanding of how to correct the problem with your nose.
 Based on your post, we don’t even really understand what the problem is.
For a second opinion, consultations patient should come prepared with a complete set up before and after pictures and a copy of your operative report. These are available from your current providers office if you request them.
Best,
Mats Hagstrom, MD

Retracted Columella - thick skin Hispanic woman

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Retracted Columella - thick skin Hispanic woman

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Everything you need to know about Rhinoplasty

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