How Can I Stabilize The Loose Base Of My Nose?

Q: Dr. Eppley, My Dr suggested that I can benefit from Rib Graft rhinoplasty about a year and half ago. At that time I did not exactly what that consist of, and I figured he knew best, so he went on and performed it. I hated the way it looked and felt. So a year later, I had him remove it. Once he removed it, my nose right underneath my lip felt loose. And when I looked in the mirror it was really visibly loose, when turn my head on either side. Another example is, when onlooker under my bed, I can feel it sliding once side to the other. He told me that he sutured the anterior nasal spine to the caudal septum, and he is depending on scar tissue hold tight. Based on their notes from the rib graft, they removed a piece in the anterior spine, but I don’t know how much they removed, because it still feels normal. Please give me your advice or a solution.

A: By your description it sounds like the columellar skin is loose. The anterior nasal spine is a bony structure and does not move. Neither does the caudal end of the septum being a cartilaginous structure. You did not say whether your rib graft rhinoplasty was a dorsal only graft or a combined L-strut dorso-columellar graft. But that issue aside, the only way to stabilize the columella is a cartilage graft placed between the medial footplates (columellar strut graft) and anchored to the anterior nasal spine.

Dr. Barry Eppley

Indianapolis, Indiana