Asian Rhinoplasty - Flat Columella and Flat Tip, What Can Be Done with Surgery? (photo)

What I really dislike about my nose is the columella, I think that's what it's called. My nostril sill goes below, giving it a somewhat of a flat projected nose in my eyes. It looks like the bottom of my nose is being pushed inward..What can be done to make it look more sharper and projected ? Also in the photo, I had very little juvederm injected into my nasion. When does a nose stop growing? I'm an 18 year old asian male.

Doctor Answers 12

Ear Cartilage For Correction of Retracted Columella

A retracted columella, plus lack of tip projection, can be cured simultaneously by conchal or ear cartilage placed into the columella through an incision inside your upper lip.  This cartilage gives you what's known as columellar show.  As previous responders have stated, the sides of your nose, known as ala, are low and this can be corrected by wedge resection.  Your nose has already stopped growing, or should stop within a year or so.

 

Your questions are excellent ones.  The standard Asian rhinoplasty deals with lack of columellar show associated with lack of tip projection, mid-face retrusion, often making the upper lip appear to stick out too far, poor dorsal projection (inadequate bridge on nose), and wide low-set ala.  I suggest you find a board-certified plastic surgeon who has experience with the non-Caucasian augmentation rhinoplasty.

Retracted columella

It is possible to place a small cartilage graft by your columella to bring it forward and make it less retracted. You could also consider placement of a cartilage graft on your bridge to provide a permanent augmentation to the area (rather than needing juvederm injections). It's hard to fully assess this since you have juvederm in place currently. Deopending on your nose's baseline appearance the tip could also be projected though right now I'm not sure if this would be necessary.

 

In males the nose usually stops growing by 18-19 years of age.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Asian rhinoplasty

Asian rhinoplasty usually involves augmenting a low bridge at the radix with a silastic implant.  A small cartilage graft can be inserted at the base of the columella to give a little more columellar show.  This can all be done through close rhinoplasty techniques under brief general anesthesia as an outpatient procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 67 reviews

Hidden columella

In the Asian nose it is usually the hanging ala hiding the columella not a retracted columella. The hanging ala can easily be lifted from a closed rhinoplasty. Columella can be added as wellwith a cartilage graft. Frequently it is a combination of both hanging ala and retracted columella.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 18 reviews

Asian rhinplasty

Many surgeons perform an asian rhinoplasty by adding either a nasal implants, or a cartilage graft.  If I saw you as a patients, I would advise against surgery at all.  You nose looks perfectly fine and attempts to build a nose up with an implant often look weird.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Asian Rhinoplasty - Flat Columella and Flat Tip, What Can Be Done with Surgery?

 The photos and what you're describing is called a "retracted Columella".  Aesthetically, the columella should show, or be visible 3-5 mm's from the profile view.  In the photo, yours is 0mm's.  The most likely solution is a plumping graft to the columella area.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Can I get a sharper more projected nose? (photos)

Your nose has stopped growing.  In the adult male, midfacial growth reaches maturity between ages 14 and 18.  The columella can be lowered, most classically, by inserting a cartilage graft (called a "columellar strut") between the medial crurae of your lower lateral cartilages.  A tip graft could be added for tip projection if you desire.  Alar base narrowing and dorsal augmentation with cartilage or a silicone implant are other commonly applied techniques.

In person evaluation of both your nose and its relationship to your other features is important before committing to surgical intervention.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 40 reviews

Asian rhinoplasty - complexities of the Asian nose

Deficient columella and an underprojecting nose are components of the Asian nose that many seek to correct. The problem with the columella is that it lacks an inferior or caudal position in comparison to the alar bases. This gives the appearance that there is not enough volume in the columella close to the anterior nasal spine. Juvederm may add some volume initially but I imagine you are looking for a more permanent solution. The other issue is a lack of projection of the nasal tip. Both of these problems can be overcome with judicious cartilage grafting, specifically creating a columellar strut from something like septal or rib cartilage.

Andre Panossian, MD, FACS
Pasadena Plastic Surgeon
5.0 out of 5 stars 1 review

Columellar Retraction

If your columella is retracted, it can be improved by placing a small piece of cartilage in that area.  The extent of the retraction will determine what needs to be done.  Please consult with a board certified specialist who can assist you in achieving the results you desire.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Flat Columella and Flat Nasal TIP

The nose has stopped growing in an 18 year old man. The retracted columella can be corrected with a small graft of your own cartilage. The base of your nose can be narrowed and the projection of your tip can be increased to improve the broad, flat appearance you want to change. An experienced surgeon can describe treatment alternatives with you. 

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

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.