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Is There an Easy Revision of Droopy Nose After a Primary Rhinoplasty? Is It Just the Columella? (photo)

I had a rhinoplasty 18 months ago and I am happy with the results but I'm still concerned about the droopy tip which even though improved is still droopy. The tip is hanging a bit even in repose but definitely more when I smile. I don't want to have the muscle cut or altered -- is it complicated to fix it without affecting the muscle underneath? I really don't want to go through a major surgery but if there is an easy fix, I would go for it. Please help me with your professional opinion!

Doctor Answers (15)

Droopy tip correction by secondary tip rhinoplasty.

+1

Your profile photo shows that the angle between your columella and your upper lip, the nasolabial angle is less than 90 degrees. it sould be about 100. The procedure is relatively simple and it can be done under local anesthesia. The tip of the nose is lifted superiorly and fixated to the septum after removing some of the lower septum. 


Morristown Plastic Surgeon
5.0 out of 5 stars 19 reviews

Fixing a Droopy Nasal Tip afer Primary Rhinoplasty

+1

The slight "droopiness" of your nose is referred to as a "hanging columella". In your pictures, this appears to be caused by a slight elongation of the midline cartilage of the nasal septum. A simple fix for this would be to trim 2 mm or so of the elongated septum. This would be a very minor procedure.

If, in addition to this, it bothers you that the tip of your nose moves when you smile, to resolve this would require a releasing incision of the muscle at the base of the nose (the nasalis muscle) to reduce the muscle's function.

At any rate, be sure to visit an experienced revision rhinoplasty surgeon (or surgeons) for a face-to-face consultation to fully assess your options before proceeding with any further course of treatment.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Closed Tip Rhinoplasty for Revision

+1

You could have an isolated tip procedure with removal of some caudal septal cartilage and a tip rotation with suture support. This could be done under a closed rhinoplasty tip procedure. This is not a hanging columella or a muscular tip problem.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 reviews

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Yes tip lifting might be easeally corrected with local sedation/si la punta nasal podria ser corregida facilmente

+1

yes if only it is the tip it might be easeally corrected trough a light local anesthesia at office instalation of course without any spetial remodelling fillers except your own fat and plastma and besides lifting cartilages  without touching the bones and septum.

si podria corregirse facilmente mediante anestesia local en la oficina sin tocar el hueso ni el tabique nasal y sin ninguna inyeccion remodelante  excepto tu propia grasa y plasma

Ramon Navarro, MD
Mexico Plastic Surgeon

Revision surgery

+1

It appears that you have some alar retraction as well as hanging columella.  You need to see a Board certified surgeon that does revision rhinoplasty to determine the best and most simply revision.  Donald  R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 5 reviews

Revision rhinoplasty can be simple or complex depending on how much needs to be changed

+1

From the posted photos, it seems that altering the tip angle might be achieved without complex surgery. However, it's important to get a personal exam to determine exactly what the cause is and therefore the best course of treatment. It might be as simple as shortening cartilage or resuspending structures. But if the support is missing it may be more involved to get a long lasting result.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Droopy nasal tip after Rhinoplasty

+1

Hello 'casablanca', thanks for your question.  There are several reasons for a droopy nasal tip, including a weak columellar support, bulky/ bulbous tip, over-resection of the nasal septum during rhinoplasty, and a hyperactive depressor septi nasi muscle.  Without more information regarding your preop and current anatomy, or the details of your rhinoplasty surgery, it is difficult to ascertain which of these may be the source.  Based on your photos alone, a columellar strut cartilage graft may help support the tip, giving you a nice result.  Also, your description that the tip droops more on animation (smiling) tells me that you would benefit from division of the depressor muscle.  I am not sure why you have an aversion to division of this muscle, which is commonly performed during rhinoplasty procedures, but it should help your concerns and would be a smaller surgery compared to your initial rhinoplasty.  Good luck!

-Dr.92660

Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 1 review

Rhinoplasty issue for revision

+1

The lateral view shows a nice profile with the tip angle a bit acute.  A slightly more elevated tip may be possible. Best to be seen in person. I do not think that the muscles have to be divided.  Good luck.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Droopy tip

+1

At 18months it is appropriate to do, what you would need, a pretty simple revision. What you need the most is a strong strut in the columella and possible shortening of the caudal septum. A Facial Plastic Surgeon with plenty of experience in Rhinoplasty and Revision Rhinoplasty should be able to help your situation.

Devinder S. Mangat, MD
Cincinnati Facial Plastic Surgeon
4.0 out of 5 stars 14 reviews

Rhinoplasty revision

+1

Being 18 months out you should be able to have a revision if you want one. The limited view photos you posted however are of little help. It is impossible to tell if you have true asymmetry or your head is tilted. I think I may see an oblique deviation of the bridge to the left and on the side view it looks like the nostril rim is elevated more than the columella is hanging. The tip lies 90 degrees to lip so slight upward rotation would be helpful.

The best thing for you to do is see your original surgeon first to see what he/she says. Then take copies of your operative report and photos to a second surgeon for a second opinion. There is no shortage of competent nasal surgeons in New York. Then decide what you want to do.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.