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Revision for Hanging Columnella and Upturned Nose Tip?

asked 2 years ago by Peony in CA
Latest answer by Manish H. Shah, MD
Question viewed 1,513 times
Tags: columella, upturned

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!

16 answers to Revision for Hanging Columnella and Upturned Nose Tip?

+2

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... more
Jon F. Harrell, DO

Miami Plastic Surgeon
+2

Revision Rhinoplasty

Bringing a tip down can be complicated. It depends on what was done to rotate it up in your original surgery. Getting your operative report from 1993 may help in this regards. As far as the hanging columella, the correction of this is relatively straight forward in most situations. You may remain swollen a bit longer that your original surgery as revision surgery can lead to this.
Norman M. Rowe, MD

New York Plastic Surgeon
+2

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.
G. Gregory Gallico III, MD

Boston Plastic Surgeon
+2

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... more
Scott Trimas, MD

Jacksonville Facial Plastic Surgeon
+2

Secondary rhinoplasty

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.
Steven Wallach, MD

Manhattan Plastic Surgeon
+2

Secondary 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.
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+2

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... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+2

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. more
Eric M. Joseph, MD

West Orange Facial Plastic Surgeon
+2

Rhinoplasty Revision

Hi Peony, 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. Dr. P
Michael A. Persky, MD

Los Angeles Facial Plastic Surgeon
+2

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... more
Steven J. Pearlman, MD

New York Facial Plastic Surgeon

www.mdface.com

+2

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... more
Peyman Solieman, MD

Beverly Hills Facial Plastic Surgeon
+1

You might need to have your nose re-lengthened.

Hello, Without seeing your photos or examining your nose it would be difficult to give you very pointed advice. However, It sounds like your nose might have been overly shortened during your first surgery. If that is the case, cartilage grafting to re-lengthen the nose and derotate it might be a reasonable solution. I would recommend that you go to see a surgeon experienced in revision or corrective rhinoplasty about your concerns. Good luck, Dr. Shah more
Manish H. Shah, MD

Denver Plastic Surgeon
+1

Rhinoplasty revision for hanging columella and upturned nose

The upturned nose can be brought back down with multiple different procedures including dorsal grafting, a full transfixion, and removing an inferior portion of the caudal septum. Removal of both membranous and cartilaginous septum along the columella can also trim back and bring in the columella so it is not hanging. This is a relatively easy repair. Look for someone who has done thousands of rhinoplasty surgeries and is very comfortable in this arena doing a rhinoplasty surgery.... more
William Portuese, MD

Seattle Facial Plastic Surgeon

www.seattlefacial.com

+1

"Upturned Nose"

Cartilage grafts will probably be necessary to derotate the tip and lengthen the nose. Although this will improve the columellar show, the septum may also be reduced. See an experienced revision rhinoplasty surgeon because this is a difficult procedure. Please don't let me discourage you; significant improvement can be achieved.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon
+1

Secondary rhinoplasty

You will probably need grafting of cartilage to bring the tip down, and you may also need some resection of your lower septum to reduce the columellar show. This can be fairly complex surgery, so you should seek the services of someone who is experienced with revision rhinoplasty surgery. If you can obtain your operative report and photographs from 1993 (this may not be possible), that will help your surgeon to plan your surgery. Your recovery will probably not be any worse than your... more
Nina S. Naidu, MD

New York Plastic Surgeon
+1

You may need ear cartilage grafting. Recovery is same as first surgery.

The deformities you described can certainly be addressed by having revision surgery. You will need cartilage grafting to de-rotate the nose. Depending on how much cartilage was taken from your septum, you may need ear cartilage used for grafting. If the surgeon feels that de-rotating the nose does not improve the hanging columella, it can be addressed by removing a small amount of cartilage from the septum, by removing some mucous membrane, by fancy suturing, or a combination of these... more
Theda C. Kontis, MD

Baltimore Facial Plastic Surgeon

facialplasticsurgerymd.com

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