I had a Rhinoplasty operation 2 years ago and was quite happy with the results at the time, but since then I have grown increasingly unhappy with the tip. I think it looks quite bulbous due to hanging columella. What is your opinion? And if necessary, how easy would it be to correct? (I can't upload my image as it's a pdf - I could email it to you if you respond? Thanks!)
Should I Go for Revision Rhinoplasty Because of Hanging Columella?
Doctor Answers (37)
Hanging columella: a good reason for revisional surgery
I just think a hanging columella is a hallmark of bad rhinoplasty. I do not like the way they look on their own and I especially do not like what they do for a person's overall look. I think they need to be fixed, but every situation is different. Send photos and operative note if you can. Every situation is different and needs to be evaluated as such.
Fixing a hanging columella through revision rhinoplasty
The columella (portion of the nose between the nostrils) can appear to be "hanging" for a multitude of reasons. It is important to address this issue with a revision rhinoplasty specialist, in order to diagnose the cause of your issue and address it appropriately. In some cases this can be as straightforward as a slight shave of the underlying medial crura of the lower lateral cartilages. More frequently, I address this issue by straightening the columella with a nice, straight piece of cartilage taken from the septum, what is called a columellar strut. In other cases, the infratip (area below the tip) is overrotated, in which case additional maneuvers or cartilage grafts to recreate a normal tip/infratip relationship may be needed. As others have mentioned, retraction of your nostrils can accentuate the problem. With photos, I would be able to analyze your situation further but hopefully this is helpful.
Hanging columella can be an unsightly deformity
See an experienced rhinoplasty surgeon in your area and have them examine your nose. If the problem is simply a hanging columella there are many procedures to improve this. However, an experienced rhinoplasty surgeon my uncover other problems that need to be addressed.
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Hanging columella can be improved
Increase in nostril show can be the result of a hanging columella and/or alar retraction and many times a combination of both. The good news is that it can be corrected with revision surgery.
Revision rhinoplasty for nasal tip and hanging columella
In situations like this, it is best to consult with a revision specialist. Bring along your pre and post-op photos and operative reports. Hopefully, your surgeon can help visualize what is bothering you about your current nasal form (and perhaps confirm what you've said). Things are usually a bit more complicated than they seem, and an experienced surgeon can help determine what revision (if any) would be right for you.
Hope this helps.
Be Careful and Select Closed Approach With A Surgeon Well Versed in Advanced Grafting Techniques
In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons. In your case, the nose DEFINITELY should not be opened a second time because the lip-columella-tip relationship is always changed with open rhinoplasty scarring and success depends largely on the design and execution of your columellar strut.
In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like at a minimum you will need a columellar strut. Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. I hope this helps!
All the best,
Rian A. Maercks M.D.
If you would add front, profile and head tilted back views of your nose we could help you more meaningfully.