How Can a Retracted Columella and Hanging Alar Be Fixed?

The hanging ala can be very subtly retracted by removing a small portion of the fibrofatty tissue on the inside of the ala to give a little bit of retraction.  A retracted columella can be augmented with a small cartilage graft to push down the columella and give more columellar show and a better alar columellar relationship.  

Dear Toronto8353, A retracted columella can be fixed.  Given your anatomy, a columellar plumping graft can be inserted in between the medial crura of the lower cartilages (which is where the cartilages meet in the middle).  This can be done using a piece of your septal cartilage, which is the cartilage that divides the 2 sides of your nose.  An extended shield graft can also be placed to not only plump up the columella, but also give the tip a little more definition... more

The treatment for a hanging alar rim is removal of a sliver of skin of the hair bearing area on the outer wall inside the nostril. The maximum width of this sliver is about 3mm because if you take out too much the rim will roll into the nostril. The treatment of for a retracted columella is a cartilage graft placed between the 2 C-shaped cartilages of the nasal tip. The graft is designed to give forward and downward projection where it is needed and is sutured to the C-shaped tip... more