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

Question

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.

Richard H. Tholen, MD, FACS · Answer

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

Ali Sajjadian, MD, FACS · Answer

Hi,

	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

Jaime Perez, MD · Answer

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

Leonard T. Yu, MD · Answer

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 patient....it will take months for things to settle and for you to judge the final result...9-12 months with noses.

Robert Shumway, MD - Account Suspended · Answer

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

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

Answers (6)