Is it hard/complicated to fix/treat a hanging columella and alar retraction? Would open or closed rhinoplasty be best? (Photo)

To repair a hanging columella requires 2 incisions placed on the inside of the nostrils, and the excess skin and cartilage is removed. To repair a alar retraction,  a combination of either alar rim grafts, or a composite skin/cartilage graft is performed on the inside of the nostrils. Both procedures can be performed easily with a closed rhinoplasty approach. For many examplesof reducing columellar show and more information, please see link below

These are all common issues that are addressed by a rhinoplasty surgeon.  I believe that you are a good candidate for rhinoplasty, where subtle changes in the tip and bridge of the nose will add up to an overall more refined appearance.  I recommend consulting a Board-Certified plastic surgeon who will accurately examine your nose, create a simulation based on what your nose could look like after surgery, and formulate a plan tailored to your individual needs and wishes.  Good luck!

Thank you for your question and photos.  You are correct that alar retraction is less commonly treated than hump removal, but there are many well trained rhinoplasty specialists who are comfortable correcting this type of issue.  Alar retraction can be treated as an isolated procedure or in combination with formal rhinoplasty (which is what I would recommend for you).  There are several techniques to bring down a retracted ala, depending on the degree of retraction and the patient's specific anatomy.  I would probably recommend composite grafts from the back of the ear to the inside of the nose to unroll and bring down your ala on each side in additional to other nasal shape concerns.  See a rhinoplasty specialist in your area who can give you a detailed examination and collaboratively make a plan to give you the nose you are hoping for.  All the best!