Revision Rhinoplasty or Columelloplasty? Which procedure would help correct hanging and asymmettrical columella? (photo)

Hello and thank you for your question. Although an exam in person is ideal, from your photograph alone it appears that you can benefit from surgical maneuvers to decrease the alar-columellar show as you stated. Operating in the columella area alone may not suffice. You may also benefit from a caudal septal trip and further tip modification. This would involve a complete revision rhinoplasty. Due to your prior rhinoplasty, the cartilage in your septum was likely harvested and so you will likely require MTF (cadaver) cartilage. The modification of your nasal cartilage can be done with trimming, stitching or grafting. If your septum is deviated and you have breathing difficulty, a septoplasty may benefit you as well.

Once all the swelling has resolved (in a year to a year and a half), the next step for you is to pursue the right aesthetic plastic surgeon for your revision rhinoplasty. In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in women who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

You should evaluate all aspects of your nose. For example, this one photo seems to indicate that your nose might still be long, with not just the columella hanging down, but the entire tip, too. If that's the case, then you should have a traditional revision rhinoplasty. Also, is the tip narrow enough? A columellaplasty, as an isolated procedure, is rare, and usually there are other things going on at the same time. The woman whose photos I put in the link with this answer had a columellaplasty and an elevation of her tip.

How *much* to elevate the tip, or narrow the tip, or just what to do with the columella, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.

You would most likely benefit from a revision rhinoplasty to address the concerns that you have stated. The decision to undergo revision rhinoplasty is a strictly personal one, as only you can weigh the pros and cons of the recovery and financial aspects relative to how much the nasal appearance bothers you. A revision rhinoplasty specialist will be able to comprehensively address the issues you have with your nose. While there are a variety of approaches and techniques employed by various surgeons, it is up to you to do your due diligence to find a rhinoplasty specialist in order to achieve the best results possible. Looking at computer-morphed images with your surgeon during consultation will give you a good idea of what is possible, and also give you a great chance to convey to your surgeon what you envision. @drdonyoo