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This one is about: Rhinoplasty: Columnella Lengthening "Lifting the Tip"

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Rhinoplasty: Columnella Lengthening
"Lifting the Tip"

by Joanne Greene

Children born with complete bilateral cleft lips often have the problem of a very short columella left after the initial lip repair. With a short columella, the tip of the nose is drawn down to the upper lip and the result is a flat profile. At approximately the age of 5 - 7 years (varying by child and by doctor) the child may be scheduled for a procedure that will lengthen the columella.

There are a number of different methods used to lengthen the columella. However, the most common method one for which the surgeon has prepared by "banking" extra tissues in the upper lip area when effecting the initial lip repair.

During the initial repair, extra tissue was left in the upper lip and the problem area was left somewhat wide. This process, while initially possibly looking a bit "different" esthetically, will provide much-needed tissues later that will ultimately give the child the best possible repair. When doing the actual columella lengthening, the surgeon will prepare two "fingers" of tissue below each nostril, primarily pulling from the existing scar tissue that was left after the initial Z-Plasty repair. The bottom of the existing columella is separated from the labial area and the two undetached "fingers" of flesh are drawn up and attached into a new columella. The labial area is then sewn together on each side, leaving a smaller, more natural-looking philitrum, with the new scars left to form what will appear to be normal philitrim lines. The edges of the nostrils are pulled in to decrease the spread of the nostrils and the sides of the labia are pulled together to make the peaks of the cupid's bow.

After the surgery there will be some swelling of the lip and considerable tenderness on the nose. Immediate after care may consist of a soft diet for a few days, cleaning of the suture line and possibly using ice-water compresses to reduce swelling. The swelling and any bruising should be gone in about 2 - 3 weeks, with the majority of the swelling gone in the first week. This surgery may be done either as an inpatient or outpatient procedure, again depending on the doctor and the child.

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