I don't like the tip of my nose. I think I have a hanging columella and retracted nostrils. I would like a softer feminine nose. What do you suggest?
I Don't Like the Tip of my Nose. I Think I Have a Hanging Columella and Retracted Nostrils. What Do You Suggest? (photo)
Doctor Answers (11)
I Think I Have a Hanging Columella and Retracted Nostrils
Thank you for your question. From your photographs it is very difficult to evaluate your nose adequately enough to give you a meaningful answer. It does seem that the tip is a little bulbous however you would need a true lateral (side) view to determine whether you have a hanging columella and retracted nostrils. I would strongly suggest that you see ether a board certified plastic surgeon or a facial plastic surgeon and have them examine your nose both externally and internally. I have found that the use of computer imaging has been very helpful in determining what can be done and in setting appropriate expectations.
Treating hanging columella & retracted nostrils
Hanging columella is treated by removal of both skin and cartilage on the columella to tuck in the columella. Alar retraction is treated best with composite skin grafts composed of both cartilage and skin taken from the ear and placed up on the inside of the nostrils to bring the alar rims down and improve nostril notching.
Nostrils and hanging columella
It is difficult to evaluate your nose with the photos you posted. Certainly if you have a hanging columella or retracted nostrils these things often can be addressed with rhinoplasty.
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Retracted Alar rim vs Hanging Columella
Based on your picture one alar rim seems to be a bit more retracted up than the other. The columella doesn't look too bad but the pictures don't allow for a proper analysis.
Rhinoplasty and droopy tip
It is impossible to say what needs to be done without an in-person examination. However, from the photos shown, there is apparent alar retraction and a hanging columella. These can be treated with a variety of methods including cartilage grafts to the alar rims and careful reduction of the columella, if possible. Make sure your surgeon is a Board-Certified expert in rhinoplasty.
One can have a hanging columella, retracted nostril rims or both. It is important to assess/diagnosis this before surgery in order to plan surgery appropriately and avoid making things worse. Because none of your posted photos is a true side view I cannot tell from the photos exactly which applies to your case, although the first photo likes like the nostril rim may be retracted. The way to assess this is on a side view where the nostril rim to outer surface of columella distance should be about 4mm. Each should be about 2mm from the mid-axis of the nostril plane. The usual surgical procedure for this involves some combination of caudal septum trimming and/or repositioning of the tip cartilages and/or placing a graft inside the nose to bring the rim down.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
I Don't Like the Tip of my Nose. I Think I Have a Hanging Columella and Retracted Nostrils. What Do You Suggest?
I have performed Rhinoplasty for over 2 decades and your nose has neither a hanging Columella nor retracted nostrils. The nasal tip is a bit wide, with thick skin and is under rotated. The tip could be refined with a Closed Rhinoplasty.
Improving the alar columellar relationship
From your photos, it appears that the nostril retraction is a bigger issue, but it needs to be seen in person. Your cartilage is shaped in a way that predisposes you to this and you would need cartilage grafting and repositioning to help improve the shape of your nose and strengthen the alar/nostril rims. If you undergo a rhinoplasty without cartilage grafting, it is likely you will see a worsening of the retraction.
See a surgeon experienced in nasal surgery to get a formal opinion.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
I think most of your problem is the retracted alar rims. Cartilage grafts are the way to correct this but, select an experienced surgeon. This not a routine provcedure
Hanging Columella and Retracted Nostrils
I agree that you do have a hanging columella and retracted nostrils which can be corrected by elevating the columella and placing cartilage grafts to lower the nostril margins. Although it is difficult to determine with the pictures submitted, the tip can be refined by decreasing the width and adding a small graft to increase projection and define the tip. See a rhinoplasty specialist to examine you, present alternatives, and establish reasonable expectations.