I had Rhinoplasty in 1993, and have always been bothered by the tip being too "upturned" and unnatural looking. Also, the columnella is hanging (I hate seeing the inside of my nostrils in profile). I am now considering a revision. How involved would fixing these two issues be (i.e. grafts, recovery time, etc.)? Thanks!
Revision for Hanging Columnella and Upturned Nose Tip?
Doctor Answers (16)
Promoted Local Answer
You may benefit from a Non-Surgical Rhinoplasty to lower your nostrils and add volume to your nose.
If your nose isn't too large, you would be surprised how much better your nose could look after an Injectable Filler treatment. You should consult a board-certified specialist experienced in using fillers in the nose. You should also see many photos before proceeding.
Feel free to email me a full-facial frontal and profile photo, and I'll be happy to share my thoughts with you.
I've attached a link to my Non-Surgical Rhinoplasty photos for your perusal.
I hope this is helpful for you.
Promoted Local Answer
Without a picture, I can't tell but it sounds like you have a typical "over-done" nose
What likely happened is that the cartilage in the tip of your nose rotated upward but the center called the septum remained stable creating the hanging columella. Yes, you got the term correctly without even knowing it. Over the years following your surgery we now know more and more about what causes these situations to arise and how to correct them, and in primary cases how to avoid this from occurring in the first place.
This can be corrected by using a number of grafts. These grafts are usually from your own cartilage. I suggest you seek out a revision rhinoplasty specialist for an examination and more specific answers for your specific needs.
Revision Rhinoplasty for Upturned Tip and Hanging Columella
How involved this will be depends upon the degree of severity of the deformity, the availablity of tissue(cartilage) to reconstruct the areas of concern and the skill/experience of your surgeon. You may require cartilage grafting to the bridge of your nose and/or tip - however the amount of work will depend on how much tissue was removed during the first surgery. Find a surgeon with experience - particularly with revisional work. This is not a 'beginner' Rhinoplasty. If you are fortunate enough to be able to procure the original operative note it will help your surgeon prepare for the procedure better. Best of Luck Dr Harrell
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For your nose tip problems, you need a tip rhinoplasty with cartilage 'work'.
Your upturned nasal tip can be turned down with cartialge grafts and your hanging columella can be hidden by cartilage resection or elevation. These are typical steps in a Tip Rhinoplasty. Have your surgeon show you in advance by computer simulation what can be done to your nose. If you like what is proposed, then do the surgery.
Over rotated nasal tip and hanging columella can occur after an agressive primary rhinoplasty
Over rotated nasal tip and hanging columella can occur after an agressive primary rhinoplasty. This can be a difficult problem to correct and is usually the result of an excessively long septum and overly rotated or shortened tip cartilages. Generally speaking and without having seen your pictures, your tip cartilages will have to be de-rotated and your tip cartilages brought downward. Grafting with septal or other cartilage from your ear or rib is likely to be required as well if there is not enough cartilage in your nose to use. I would strongly recommend a surgeon who is very familiar with revision rhinoplasties and has performed surgery on patients with a foreshortened or as some people call it a porcine nose.
The tip more than likely can be de-rotated and the columella show can probably be improved upon. The recovery woould probably be similar to your first rhinoplasty.
An upturned or short nose can be somewhat difficult to treat and may require cartilage grafts to push the nasal tip down. Secondary rhinoplasty can be complex and you should clearly seek the services of an experienced rhinoplasty surgeon.
Correcting hanging columella and upturned nose tip
The overly rotated nasal tip is a rather common complication of rhinoplasty with scar tissue pulling the tip up and over the lower edge of the cartilage nous septum. The side appearance can be improved by a little filler injection along the top of the nose (But this will not diminish visibility of the nostrils on frontal view).
A repair of this would require separation of the lower lateral cartilages from the septum (which is done when a hanging columella is narrowed anyway) and fixation of the tip in a lower, de-rotated more attractive location. (The operation is slightly more involved than a tip rhinoplasty but less complicated than a full rhinoplasty)
It is difficult to answer your question accurately without either examining your nose or having some photos to evaluate.
Most likely the procedure would involve cartilaginous grafts. Consult with a few experienced rhinoplasty surgeons, and then make your choice of surgeon carefully.
Good luck and be well.
Difficult to give simple answer without seeing pictures
Dear Peony in Cali,
Revision surgery as you know is intricate and very individualized. Correcting an upturned nose with a hanging columella can run the entire gamet from very difficult to relatively simple depending on your particular anatomy and what was done in your previous surgery.
There are a number of techniques that can be utilized to correct the hanging columella. Occasionally, however patients who think they have hanging columella also have notching of the ala which can require composite grafts for correction. The "upturned" quality can also be simply a matter of suturing your cartilage into better position all the way to requiring grafting, depending on your particular case.
The point of all this is that you should be hopeful because in the right hands you should find a surgeon who will take the time to examine you, listen to your aesthetics and then will explain the plan to achieve the results you are seeking. Most importantly look for someone who specializes in revision rhinoplasty and make sure they take the time to answer your questions and understand what you want so that this can be the last time you need surgery.
If you have more specific questions feel free to email us.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.