Strategy for correction of columellar show, wide alar base and arched nostrils.
I think your assessment is accurate, and there are several maneuvers to address each problem. These include alar base narrowing with small incisions hidden in the alar crease and sill area, recessing the columella to reduce the excess hang, and placing cartilage rim grafts of your own septal cartilage to correct the arching of the alar rims. The goal is to achieve correct alar- columellar parallel relationship. These are appropriate procedures to discuss in consultation, along with computer imaging, and reviewing pre and post ops of previous patients with conditions similar to yours. Hope this helps!
You have some arching of the alar rim this causes the columella to be more visible but a surgical correction would involve alar rim grafts. Lowering the alar rim is not an easy task but a definite improvement could be made with a rhinoplasty
In lieu of a physical exam, what would you suggest be done.
Long arched nostrils, too much columellar show, probably a very good assessment of things you don't like. Any of us could say you should fix them, but only a consultation can reveal exactly how your rhinoplasty should be carried out. Computer simulation is a very important tool to see how things might work out, and many surgeons offer a complimentary consultation, so take advantage.
I agree with your self assessment. A formal rhinoplasty with tip shaping sutures and columellar work would enhance your appearance.
Arched nostrils and hanging columella
You have described the condition with the precision of a rhinoplasty surgeon. The combination of both conditions makes the nostrils look wide with flared. It can be reduced very well with an alarplasty. If the alarplasty does not completely correct it, then resection of the membranous septum in the shape of a vertical ellipse can pull back (superiorly or cephalic) the columella and fix the problem.
In lieu of a physical exam, what would you suggest be done to achieve a more aesthetically pleasing nose?
Best to obtain ONLY IN PERSON examinations. But I believe you would need a full rhinoplasty. Best to you...
Thank you for your pictures. Rhinoplasty surgery has to be flexible, in that the surgeon forms a "game plan," but has to be willing to modify it intra-operatively. You do have a hanging columella which does have to be shortened. Currently it also appears that your nose is short and needs lenghtening. For example on the profile view the tip appears too turned up. Once a conservative hump removal is done and the columella trimmed, that may not seem as much of a problem, or it could get worse. That would need to be addressed.
You do have arched nostrils that should be able to be fixed with cartilage grafts. The front view can be improved with modification of the attachments of the upper lateral cartilages with the septal cartilage. I am saying this based on your pictures, but another plastic surgeon may have a different point of view after examinig you. Good luck in your journey.
Rhinoplasty for hanging columella , arched alae, etc.
Rhinoplasty for hanging columella , arched alae, etc. can all be corrected. See an experienced rhinoplasty surgeon for the best results and one who does natural noses.
Answers bullet points
1. Hanging columella - can be easily fixed , width can be corrected too, no problem. 2. Nostrils can definitely be reduced in size however when the tip shape changes the shape of the nostrils as well as their size may change and become smaller so I would rather start with that. HAnging columella and columellar show are essentially the one and same thing.