Your question: Can my columella deformity be corrected? Photo
I have what appears to be a deformity in my columella. I am a 31 year old male and have had this condition since birth. In addition to having a very defined ridge between the two sides of the columella, it also appears that the right side hangs, while the left side does not hang. Furthermore, the ridge between the two sides of the columella, it not straight - it sort runs diagonal between my nostrils. Is a correctable condition and what the process would involve? Thank you
Dr. Denenberg's answer: Yes it can be improved. But your surgeon has to proceed with caution...
See the Web reference link, just below my response. I made some images out of the photos you submitted, to show and explain some important considerations in fixing your tip asymmetry.
The main point is that, despite the wild asymmetry at the base of your nose, many features of your tip are very symmetric, and your surgeon must be careful not to harm those symmetries. Those asymmetric cartilages that separate your right from left nostril are the same cartilages that form the size and shape of the tip of your nose. Working on one will affect the other. For example, if the surgeon simply sews the two cartilages at the bottom of your nose to each other, to eliminate the dent, it will probably torque the cartilages and ruin the shape and symmetry of the tip of your nose as seen when someone is looking at you face to face.
That dent should be addressed mostly by filling the dent in, probably with crushed cartilage stolen from your septum, and then, as I show in the Web reference link, by trimming the bottom of the left cartilage so that the very bottom of the nose looks more symmetric from the frontal view, and so that the profile view looks shorter and more even.
You should understand that these changes require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the Web reference link on how to stay out of trouble while searching for a rhinoplasty surgeon.
1) Proposed before and after. Note how the nose looks a little shorter, just because the more-drooping left cartilage is elevated. It's the left cartilage that we see hanging down more than the right:
Another view. Look how symmetric the contours of your nose are on the bottom view, despite the very asymmetric dent between the cartilages:
Another view of that symmetry:
2) Click here to comment on those changes, or to ask Dr. Denenberg a follow-up question.
3) Click here to see more rhinoplasty before and afters of patients with combinations of features to correct.
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Plain talk about picking a plastic surgeon for your first-time or revision rhinoplasty.
I do lots and lots of revision rhinoplasties; I'll try to give you some advice here, to maximize the chances that you'll be happy after surgery, and to minimize the chances you'll need a revision.
Important!! How to tell whether your consultation was acceptable:
Photos. If a surgeon doesn't show you before and after photographs, scratch him off of your list. Period. No exceptions. Deal-breaker.
You pick a surgeon primarily from his before and after photos. Diplomas, board certifications, hospital affiliations, academic appointment, and even reputation tell you nothing: a surgeon is never tested for his skill, his artistic eye, the quality of his outcomes, or even whether he cares that his patients are happy.
You must see photos of other patients who had some features similar to your nose. For example, if your nose has a wide and drooping tip, don't accept profile-only photos of patients who had a hump carved down. You can't see the width of the tip on a profile photo.
Revision nose operations are much more difficult than first-time operations, so if you are consulting a surgeon about a revision operation, you must see photos of his revision patients.
If you do see the surgeon's photos, but you don't love them, scratch him off your list. You want to use a surgeon whose work you like. Don't assume that he'll do great on you when he didn't do great on the other people.
Thought experiment: you are going to hire a portrait painter to paint your portrait. Would you really hire the painter if he wouldn't show you any of his other portraits?! No, it would never occur to you to hire him. Well, now you're going to hire a surgeon to change your nose, in the middle of your face, and you aren't going to insist on seeing examples of his work, proof that he knows what he's doing? Think about it. Teach your friends.
Communication. If the doctor treats you disrespectfully, scratch him off your list. If he won't patiently listen to what you want for your nose, same thing. How will he know how to make you happy if he won't hear what you want for your nose?
If he conducts the consultation from behind his desk and doesn't examine your nose, deal-breaker. If it's the nurse and not the surgeon who conducts the consultation, run away fastest. All due respect to the nurse, she doesn't know what's possible and what isn't. If the plan is to see the surgeon for the first time on the morning of surgery, deal-breaker. For sure.
Computer morphing. If the surgeon doesn't do computer morphing of your nose, scratch him off your list. The morphing is crucial, so the surgeon can prove to you that he understands exactly what your goals are. Also, if the surgeon recommends some changes that you hadn't thought of, you need to see the morphs, so you can see whether you like those changes.
Your intuition. If your gut tells you "no," don't use the surgeon. Don't ever use a surgeon only because you know him, or your kids know him, or he lives on your street, or your primary care doctor referred you to him, or he did your breasts, or your tonsils, or your wisdom teeth, or you saw his advertisement, or his awards.
I hear these stories all the time from my revision rhinoplasty patients. You must do your own evaluation of any surgeon you visit. And by "evaluation," again, we're talking mostly about seeing his photos and seeing how well he communicates with you. Don't bother checking the surgeon's licensure and board certification and hospital affiliations and all that; it'll just distract you from what's important.
Conclusion. The fact is, the great majority of plastic surgeons who perform rhinoplasty shouldn't be doing the operation. It's an incredibly difficult procedure, technically demanding, requiring experience, skill, judgment, an artistic eye, an exceptional level of communication and thoughtfulness, and a rare level of empathy and caring for the patient. No hospital board protects you by judging the quality of a surgeon's rhinoplasties and prohibiting him from operating if he's terrible. It's the wild, wild west out there, folks.
More plain talk: should you let your primary surgeon perform your revision?
First, you need to consider whether things didn't turn out great on your first operation because of some unusual circumstance with the surgery or the healing, or whether things went wrong because your doctor was not expert in rhinoplasty in the first place.
Evaluate your surgeon again. Read the section above, on how to evaluate a surgeon for a rhinoplasty. If you saw lots of before and after photos of your surgeon's other patients who got excellent results, in noses at least somewhat similar to yours, then your surgeon probably knows what he is doing, and you can consider letting him perform your revision. Even the very best surgeon has the occasional disappointing result.
However, if, on looking back, you decide that you did not do excellent research on your original surgeon -- perhaps you relied on a referral, or on his board certification, without being able to see his photos -- then you probably should not have him perform the revision. If he couldn't get you close to your goal the first time because of a lack of skill, he will have no chance at all on the second try, and then you'll be in the tough position of looking for a third operation.
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