Nasal Bone Osteotomy with Narrowing, Columellar Scar Revision

Treatment details: Nasal Bone Osteotomy with Narrowing, Columellar Scar Revision

Two separate problems were addressed in one operation: the width of the nasal bones and a scar at the columella. The osteotomies bring the bony sidewalls inward to narrow the dorsum, while the columellar work is a soft tissue revision that has nothing to do with the bone but affects how the base of the nose reads on close inspection. Doing both together avoids a second recovery period. At two months the bones have consolidated and the bruising has cleared, though the tip and the skin over the dorsum remain slightly thickened. Nasal swelling resolves slowly and definition continues to sharpen through six to twelve months.

The nasal bones are cut and moved, so bruising spreads into both eyelids and swelling is heaviest for ten days while a splint is worn. Blocked breathing, watering eyes and blurred vision from lid swelling are common in the first days and settle. Numbness of the tip can last months. Bleeding, infection, a step or ridge that can be felt, asymmetry and a shape that needs revision are the recognized risks. Fine swelling continues to reduce for six to twelve months.

The revised scar is red, raised and firm for the first months and softens gradually over a year. Tension on the columella affects the vascular supply of that skin, so healing can be slow and the edge may separate slightly. A scar cannot be made invisible; the aim is a narrower, flatter line, and thickened or keloid healing can return in people prone to it, sometimes needing injections or taping. Numbness around the scar is temporary. Further revision is occasionally required.