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Should I Go for Revision Rhinoplasty Because of Hanging Columella?

asked 3 years ago by pinklady in London
Latest answer by Pramit Malhotra, MD
Question viewed 7,859 times

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!)

28 answers to Should I Go for Revision Rhinoplasty Because of Hanging Columella?

+1

Should I have Revision Rhinoplasty for a hanging columella.

A hanigng columella alone should not make the entire tip appear wide or bulbous. Pictures, of your nose would be helpful. If that's the only issue, the columella can be lifted through an isolated columella incision.
Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon

drfrancispalmer.com

+1

Revison Rhinoplasty To Correct Hanging Columella, Retracted ALa and Bulbosity of nasal Tip

Hi Pinklady, Fixing hanging Camella is fairly straightforward. A skilled surgeon can correct this problem very easily through incisions inside the nose. You could have it done under local anesthesia. Choose your surgeon carefully. You want to make sure that you don't have a retraction Ala as these two conditions can be sometimes mistaken or they can co-exist. With regards to the problem of nasal tip bulbosity that you had mentioned, it can be corrected through revision... more
Ali Sajjadian, MD

Orange County Plastic Surgeon

www.DrSajjadian.com

+2

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.
Jay Calvert, MD

Beverly Hills Plastic Surgeon
+2

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,... more
Umang Mehta, MD

Bay Area Facial Plastic Surgeon

www.mehtaplasticsurgery.com

+2

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.
Robert Mounsey, MD

Toronto Facial Plastic Surgeon
+2

Hanging columella can be improved

Increase 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

seattleface.com

+2

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.
Sam Most, MD

Bay Area Facial Plastic Surgeon
+1

First diagnose if the issue is the columella or alar retraction

The first step is to make sure if the columella is the issue, or your nostril/ala is the problem. These two structures have a ying yang relationship. Retracted alae are very common after rhinoplasty maneuvers that try and reduce bulbosity in the nasal tip. As patients heal in the tip region there ala can pull giving a flared nostril appearance. The solution to the problem is sometimes working on both the columella and the ala. Pick a surgeon in your... more
Pramit Malhotra, MD

Ann Arbor Plastic Surgeon
+1

Correction of the hanging columella by revision rhinoplasty

I'm going take the liberty to make a few assumptions regarding your hanging columella since there are no enclosed photos. After your primary surgery the hanging columella and nostril retraction developed over the first year. The origins of these problems are complex and located in the details of your operation and your preop photos. Generally the hanging columella can be caused by over rotation of the tip without compensating with caudal septum. It is common to have... more
Paul S. Howard, MD

Birmingham Plastic Surgeon
+1

Correction of a Hanging Columella

A photo would be extremely helpful to determine what your actual issue is in regards to your nose. A hanging columella can be due to retraction of the nostrils/alar rim or a "hanging" of the columella due to a prominent nasal spine or other cartilage issues. Either way the problem is reversible but a proper evaluation and understanding of the underlying cause is essential in order to produce a proper result from revision surgery. A bulbous tip is a secondary issue that needs to be... more
Gary Motykie, MD

Los Angeles Plastic Surgeon
+1

Unhappy with tip , seek consultation

There are several issues you bring up; question of hanging columella, bulbous tip, etc. Even with photos it would be difficult to determine exactly what your needs are and your impresssions are without actually visiting with a physician. In the US free consultations are pretty common, just be sure you are dealing with a Boeard Certified Plastic Surgeon. I hope this information has been useful to you. Jon I Sattler, MD, Board Certified Plastic Surgeon, Glendora,... more
Jon Sattler, MD

Glendora Plastic Surgeon
+1

Correction of the Hanging Columella

The hanging columella is a complex topic without specifically analyzing one’s nose. It can be due to many different things such as previous nasal surgery, a prominent nasal septum, or can actually be a true hanging columella with retraction of the alar rim. It can be multi-factorial and can be quite difficult to correct. Obviously if it’s a secondary deformity it requires significant analysis as well as operative correction with either cartilage grafts to either lower the alar... more
Rod J. Rohrich, MD

Dallas Plastic Surgeon
+1

Revision Rhinoplasty for a Hanging Columella?

This may be a relatively easy problem to fix requiring only local anesthesia and small incisions inside the nose. You won't need any exposure of the tip or bridge of the nose so there won't be as much swelling. Best of luck!
Anand D. Patel, MD

Austin Facial Plastic Surgeon

www.freshfaceaustin.com

+1

Absolutely!

Those are both very typical reasons why people go through revision rhinoplasty.  You need to make sure you have a surgeon who is an expert in REVISION rhinoplasty.  I would be happy to review your photos if you would like.
Babak Azizzadeh, MD

Beverly Hills Facial Plastic Surgeon
+1

Hanging columella and rhinoplasty

A hanging columella is a reason to undergo revision work on a rhinoplasty.  The procedure is not very difficult and requires knowledge of tip/septum/nostril  proportions.
Raffy Karamanoukian, MD

Los Angeles Plastic Surgeon
+1

Hanging columella - see an experienced revision rhinoplasty surgeon.

You are right.  A picture is worth a thousand words.  Email me some pics if possible...dr.athre [at] athresurgical.com. There are several reason that you could have a hanging columella.  A revision rhinoplasty can correct this.  However it is important to determine why you have a hanging columella first.  This is why you should see a surgeon that specializes in revision rhinoplasty.
Raghu Athre, MD

Houston Facial Plastic Surgeon

www.athresurgical.com

+1

Hanging Columella Correction

One of the most common errors of omission from rhinoplasty surgeons are inability to address the hanging columella.  There are a variety of solutions to correct this based on what needs to be changed in your nose.  Seek a consultation with an experienced rhinoplasty revision surgeon.
Anil R. Shah, MD

Chicago Facial Plastic Surgeon
+1

Revision surgery can correct a hanging columella

Revision rhinoplasty surgery can correct the issues you're concerned about. You do want to make sure that there is no alar retraction contributing to the problem. This can also be repair but is a bit more involved. A bulbous nasal tip can typically be improved upon as well. The methods to address this problem vary depending on your specific situation.
Thomas A Lamperti, MD

Seattle Facial Plastic Surgeon

www.drlamperti.com

+1

Correcting a Hanging Columella

If your problem indeed is mostly related to a hanging columella, this can be corrected in a relatively straight forward fashion by an experienced revision rhinoplasty specialist. This usually involves making incisions on both sides of the columella and repositioning the underlying cartilage to achieve the desired shape. It typically takes 15-30 minutes under a local anesthesia to accomplish this. 
John M. Hilinski, MD

San Diego Facial Plastic Surgeon

www.drhilinski.com

+1

Hanging Columella

The 'Hanging' Columella can usually be adjusted easily. Sometimes the position of the ala can be contributing to the problem and in some cases the ala themselves may need to be adjusted. As for the columella - a trim of skin or septum or even lower lateral cartilage may be beneficial. It really shouldn't be a large procedure. Good Luck
Jon F. Harrell, DO

Miami Plastic Surgeon
+1

Hanging columella

Generally a hanging columella is a simple problem to correct and can be done in 15 minutes under local anesthesia. If the problem is more complicated such as bowed medial crura causing the columella hang then more aggressive columella work may be necessary; but still could be done under local anesthesia in 30-45 minutes.
Richard Galitz, MD

Miami Facial Plastic Surgeon
+1

Revision Rhinoplasty consideration for Hanging Columella

Revision rhinoplasty is sometimes considered after the original rhinoplasty surgery to further improve the nasal appearance. Deciding on revision rhinoplasty is usually a difficult decision for both patient and surgeon. Some revision procedures are much easier than other rhinoplasty surgeries. If you're not satisfied with the columella, then a revision may be considered to push it back or similar procedure. Revision procedures are generally not performed right away, but after sufficient... more
Houtan Chaboki, MD

Washington DC Facial Plastic Surgeon
+1

Revision rhinoplasty for a hanging columella

After a patient has had a rhinoplasty, a small number of patients may choose to correct a small area of their nose that they feel was not adequately treated with the initial surgery. If having too much flesh in your columella or too low of a columella is a concern to you, this can readily be fixed with a revision rhinoplasty. Keep in mind that revision rhinoplasties can be more challenging than the first surgery so your best bet is to only work with a board-certified plastic surgeon who has... more
B. Pat Pazmino, MD

Miami Plastic Surgeon
+1

A hanging collumela can easily be fixed.

Of all the secondary deformities after rhinoplasty, a hanging collumela is one of the easiest to correct. And a s a general rule the easier something is, the more successful the result becomes. Plus if nothing else is needed, the degree of revision surgery is reduced so your recovery is faster and easier too. So good luck, I'm optimistic you will be happy after wards.
Oakley Smith, MD

Toronto Facial Plastic Surgeon

www.droakleysmithrhinoplasty.com

+1

Find a revision rhinoplasty surgeon to consult with regarding your concerns

The concerns you mention are two fold: tip definition and hanging columella. These are addressed in significantly different ways. I would suggest visiting with a rhinoplasty specialist to determine if you goals for your nose are attainable.
D.J. Verret, MD

Dallas Facial Plastic Surgeon
+1

Hanging Columella

If you're not satisfied wit the columella and tip,I would encourage you to consider a revision. The columella can be raised. While the hanging columella may contribute to to the "bulbous" appearance, you may need additional work to achieve better tip definition. Some seasoned advice would be in order.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon
+1

Hanging collumella can be fixed

You really mention two concerns in your question: tip bulbosity and hanging columella. The hanging collumella refers to the piece of tissue in between your nostrils that hangs down. In a hanging columella you see too much of this tissue and the nose appears droopy. You also see too much nostril from the side view. This can usually be fixed with revision surgery to correct the problem. Tip bulbosity usually means the tip appears too round or wide. It would not usually be related to a hanging... more
Richard Rival, MD

Toronto Facial Plastic Surgeon
+1

Hanging columella can be fixed

Hi Pinklady, You mention that you are unhappy with the columella hanging and also refer to the bulbousity. The two generally are unrelated though. If it is a hanging columella only that is concerning you, then fixing this is usually fairly straightforward and can be done closed (incisions on the inside). If your tip is bulbous the extent to what you need done to achieve your goals is difficult to say without examining you or at least seeing your photos. Often, I will treat persisitent... more
Steven H. Dayan, MD

Chicago Facial Plastic Surgeon

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