Should I Go for Revision Rhinoplasty Because of Hanging Columella?

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!)

Doctor Answers (37)

Hanging columella: a good reason for revisional surgery

+2

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.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 24 reviews

Fixing a hanging columella through revision rhinoplasty

+2

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.

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Hanging columella can be an unsightly deformity

+2

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.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

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Hanging columella can be improved

+2

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.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 139 reviews

Revision rhinoplasty for nasal tip and hanging columella

+2

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.

Sam Most, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Be Careful and Select Closed Approach With A Surgeon Well Versed in Advanced Grafting Techniques

+1
Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

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.

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 32 reviews

Hanging Columella

+1
Unfortunately, one of the most undesirable features of poor rhinoplasty outcome is a hanging columella. This often is the product of use of a columella strut on someone who has normal columella show without retracting the structures behind the columella or using a narrow graft. Sometimes if the nostril rims retract for a variety reasons during the healing may provide perception of protruding columella while this is a relative excessive columella show. When the retracted nostril rims are corrected the columella show will reduce significantly or disappear completely.
If you would add front, profile and head tilted back views of your nose we could help you more meaningfully.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.5 out of 5 stars 7 reviews

Hanging columella after rhinoplasty

+1
Hanging columella after rhinoplasty can be corrected through a revision procedure and usually is not too complicated or expensive to perform.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Rhinoplasty for Hanging Columella

+1
A rhinoplasty procedure intended to correct a hanging columella is relatively easy and popular. The surgery is minimally invasive and requires a small incision to be made on the inside of the nose, during which time the patient remains under anesthesia and is generally unaware of pain and his/her surroundings. A nose job for a hanging columella can have profound effects that no other means can attain, reducing the visibility of the nostrils and making your appearance more balanced. If you do indeed decide to go forward with rhinoplasty to reshape your hanging columella, I recommend that you consult a surgeon with adequate experience and with whom you feel comfortable.

Sam Rizk, MD
New York Facial Plastic Surgeon
4.0 out of 5 stars 18 reviews

revision rhinoplasty for hanging columella

+1
 The hanging columella is addressed with a columellar-plasty.   To perform a columellar-plasty, skin and caudal septal cartilage are trimmed back and the new columella is sewn inwards and upwards. It is important not to over rotate the tip. For many examples please see the link below to our columellar-plasty photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

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