Crooked Tip and Columella After Rhinoplasty
Cases in which the nasal tip and columella become crooked and nasal obstruction develops after rhinoplasty are surprisingly common.
There are 4 commonly cited causes.
01. The nasal implant was placed crooked
02. The columella became crooked because the columellar strut was sutured incorrectly when it was fixed
03. The septal extension graft was placed on one side only
04. The cartilage graft placed on the tip sits off to one side
Case 2: Crooked Tip and Columella After Rhinoplasty
Past History- 7 years ago, silicone + septal strut + ear cartilage at another clinic (open approach)
2 years ago, the tip cartilage became prominent and was trimmed.
Chief Complaint- Foreign body sensation in the right side of the tip. / Slightly upturned nose. / Nostril asymmetry
Physical Examination- The silicone was shifted to the left, with nostril asymmetry.
A piece of grafted cartilage protruded inside the right side of the nose.
The tip was firm, fixed, and immobile.
WANT- "I don't want anything else put back in. As long as it doesn't turn up any more than it is now, that's fine."
PLAN- Removal of (silicone + septal strut + derotation + ear cartilage onlay) + tip cartilage repositioning
The cartilage protruding inside the right side of the nose was judged to be a protruding piece of
This was judged to be a protruding piece of the derotation graft.
Nothing was visible inside the left side.
All of the implant and grafted cartilage were removed through an incision inside the nose alone (closed approach).
After surgery, the columella is straight and the nostrils are symmetric.
After surgery, the nasal bridge was brought back to the midline and straightened, and the symmetry of the tip was restored.
The tip is well projected and looks natural.
Seen from below as well, nostril symmetry has improved and the crooked tip has returned to the midline.
Patients often worry that the nose will become short and blunt once the implant is removed, but that is not actually the case.
After the removal surgery, the tip is more projected and longer.
The dorsal line is natural, and the bridge has not become much lower.
