Crooked Tip and Columella & Nostril Asymmetry Case Study 2

After rhinoplasty, it is surprisingly common for the tip and columella to become crooked and the nostrils asymmetric, accompanied by nasal obstruction. Unhappy with how it looks and stressed every time they see it, patients go back to the clinic that performed the surgery, "The swelling has not fully gone down and things have not settled yet, so let's wait a little longer," they are told. Quite a few of them wait 2-3 months, see no improvement, and then come to my clinic.

A crooked columella and tip and asymmetric nostrils after rhinoplasty are stressful enough, and patients are anxious and worried, unsure whether it will improve on its own with time or needs to be corrected.

However, this never improves on its own simply by waiting. Corrective surgery must be performed to regain the original appearance.





To correct this, the cause must first be identified with an endoscope and careful examination, and then the twisted tip cartilages and septum must be returned to the exact midline. Technically, there are two methods.

As the endoscopic photo shows, the protrusion in the left nostril was a septal extension graft,

which was found during surgery to be mesh.

In the photo taken right after surgery, the protrusion inside the patient's left nostril is gone,

and the columella and nostrils are straight and symmetric.

The removed material was silicone, capsule, and mesh (the septal extension material). (Right photo)

The crooked tip is now straight.

Because this is 4 weeks after surgery, contraction has begun

and the tip looks slightly pinched in, but this gradually relaxes, so there is no need to worry.

With removal + closed simple repositioning, the septal extension graft protruding into the left nostril is gone,

and the columella, which had curved to the right, is straight.

After surgery, the tip is slimmer and more natural.

This was pressing on the alar cartilage of the tip and pushing it crooked toward the opposite side.

After the silicone was removed, it was used to fill the sunken area at the glabella.

After the crooked silicone and the tip cartilage graft were all removed and simple repositioning of the tip cartilages was performed,

the dorsum and tip settled in straight.

The change in the columella before and after surgery.

Even with closed-approach removal + simple repositioning alone, the crooked columella and nostril asymmetry can be seen to be corrected.

The contraction period lasts up to 3-6 months, and this point, 1 month after surgery, is when it is strongest.

If the contraction is released early with active massage and rehabilitation from 1 month after removal,

the tip softens sooner and becomes freely movable.

With removal and closed simple repositioning alone, the profile line of the nose became natural and attractive.

After removal, the artificial look caused by the high glabella and long nose became natural.

People often worry that problems like those above will appear once the implant and cartilage grafts are removed.

However, even with a closed approach like this, it is possible to return to one's own natural nose.