Is It Too Soon to Be Worrying About a Notched Columella? (photo)

I think the incision on the columella was not stitched closed correctly. The two sides (above and below the incision) do not appear to be aligned, and it looks like they are on two different levels. I am 8 days post opp. Is it too soon to be worrying? I thought I had chosen a good surgeon and the rest of my nose looks great (dorsal hump gone) but I am really freaking out now that I will still hate my profile because it will look like there's a notch in the columella.

Doctor Answers 6

Notched columella after open rhinoplasty can be prevented!

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None of my colleagues have mentioned the main reason the tissues anterior to (in front of) your columellar incision are swollen, and the tissues posterior to (behind) the incision are not swollen (or less so), causing the "notch" you see (Thanks for the photos).

When an open rhinoplasty is performed, the skin and soft tissues from the incision anteriorly towards the tip of the nose are separated form the underlying cartilages, in order to access, visualize, and operate on these structures. Most of the time, no surgery is done posterior to the columellar incision towards the base of the nose/lip region, and this skin is not elevated or separated from the underlying structures. Therefore, this area does not swell (as much) as the elevated tissues of the columella anterior to the incision, which only becomes more visible early post-op as more swelling is pulled by gravity into these tissues which have lost their venous and lymphatic connections. Eventually they heal and recover, and the swelling and notch goes away. Hence, the advice from my colleagues that this will take time, but will (evewntually) get better.

Even when I don't operate behind the columellar incision towards the base of the nose, I always elevate the skin posterior to the incision just as I do in front of the incision. This way, everything swells evenly, and no notch early (when swollen) or late (when everything settles down). Much better; fewer unhappy patients! Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Notched Columella After Rhinoplasty

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After only 8 days you should not worry about a notched columella. It takes up to nine months for the nose to take true shape and size, and up to one year to completely heal. Throughout the healing process the nose will change significantly and the minor notch will most likely resolve itself.

Jaime Perez, MD
Rhinoplasty Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews


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Eight days become sixteen and so-forth, until 365 days give you the nice results we all are hoping you receive!

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Too Early To Assess Your Final Results

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Thank you for sharing your photos.

As you have mentioned, at 8 days post-op it is way too early to assess the results of your surgery. 

I recommend that you be a little more patient and make sure to follow your surgeon's instructions religiously. 

Keeping your nose safe from any possible nasal trauma is crucial as it may affect your end-results considerably.

I hope this helps.

Thank you for your inquiry.

The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Notched Coloumella 8 Days after Rhinoplasty

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At 8 days it is impossible to evaluate your result. Even if the columella does not improve, which is unlikely, it is very easy to revise this under local anesthesia.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Columellar scar

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It is way too early to look at your scar so closely.   Remember that healing involves gravity pulling swelling downward.  Your columella will be the last spot to heal completely.  Be will take months for things to settle and for you to judge the final result...9-12 months with noses.

Leonard T. Yu, MD
Maui Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.