Hanging Columella: It hangs all the time even when I smile, it makes it more apparent.
Doctor Answers 3
Hanging columella of the nose
It is difficult to say what would be best in your case because the photo is limited to 1 angle of view, small in size and out of focus when enlarged. What appears as a hanging or protruding columella (strip of skin between the nostrils) can be due to an actual protrusion of this area or retraction of the outer rims of the nostrils or some combination of these 2 processes. The difference is diagnosed on a side view by measuring the distance of the rims and outer edge of the columella from the mid-axis of the nostril. They should each be 2mm with a total distance between outer edge of nostril rim and outer edge of columella being 4mm.
I suspect in your case the issue is more protruding columella than it is retracted nostril rims. In that case the recommended treatment is cutting back the lower or caudal edge of the septum the requisite number of millimeters to achieve the final total 4mm goal.That in and of itself can be done open (with an incision on the columella) or closed (all incisions inside the nose). No amount of botox or filler can reduce this "hang".
On the referenced web page the lower set of photos shows a slightly hanging columella that I reduced.
Rhinoplasty for Hanging Collumela
A hanging collumela can certainly be improved with a rhinoplasty procedure and is a common request from my patients. You should consult with a surgeon that specializes in rhinoplasty in order to evaluate your entire face and explore the possibilities.
This isn't a great photo to plan your surgery, but yes the correction is very possible. There are many techniques that can raise a hanging columella while preserving the rest of your nose. Consult your board certified plastic surgeon.