Revision for Hanging Columnella and Upturned Nose Tip?

I had Rhinoplasty in 1993, and have always been bothered by the tip being too "upturned" and unnatural looking. Also, the columnella is hanging (I hate seeing the inside of my nostrils in profile). I am now considering a revision. How involved would fixing these two issues be (i.e. grafts, recovery time, etc.)? Thanks!

Doctor Answers 16

Revision Rhinoplasty for Upturned Tip and Hanging Columella

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How involved this will be depends upon the degree of severity  of the deformity, the availablity of tissue(cartilage) to reconstruct the areas of concern and the skill/experience of your surgeon. You may require cartilage grafting to the bridge of your nose and/or tip - however the amount of work will depend on how much tissue was removed during the first surgery. Find a surgeon with experience - particularly with revisional work. This is not a 'beginner' Rhinoplasty. If you are fortunate enough to be able to procure the original operative note it will help your surgeon prepare for the procedure better. Best of Luck  Dr Harrell

Rhinoplasty revision for hanging columella and upturned nose

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The upturned nose can be brought back down with multiple different procedures including dorsal grafting, a full transfixion, and removing an inferior portion of the caudal septum. Removal of both membranous and cartilaginous septum along the columella can also trim back and bring in the columella so it is not hanging. This is a relatively easy repair. Look for someone who has done thousands of rhinoplasty surgeries and is very comfortable in this arena doing a rhinoplasty surgery.

"Upturned Nose"

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Cartilage grafts will probably be necessary to derotate the tip and lengthen the nose. Although this will improve the columellar show, the septum may also be reduced. See an experienced revision rhinoplasty surgeon because this is a difficult procedure. Please don't let me discourage you; significant improvement can be achieved.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

For your nose tip problems, you need a tip rhinoplasty with cartilage 'work'.

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Your upturned nasal tip can be turned down with cartialge grafts and your hanging columella can be hidden by cartilage resection or elevation. These are typical steps in a Tip Rhinoplasty. Have your surgeon show you in advance by computer simulation what can be done to your nose. If you like what is proposed, then do the surgery.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Over rotated nasal tip and hanging columella can occur after an agressive primary rhinoplasty

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Over rotated nasal tip and hanging columella can occur after an agressive primary rhinoplasty. This can be a difficult problem to correct and is usually the result of an excessively long septum and overly rotated or shortened tip cartilages. Generally speaking and without having seen your pictures, your tip cartilages will have to be de-rotated and your tip cartilages brought downward. Grafting with septal or other cartilage from your ear or rib is likely to be required as well if there is not enough cartilage in your nose to use. I would strongly recommend a surgeon who is very familiar with revision rhinoplasties and has performed surgery on patients with a foreshortened or as some people call it a porcine nose.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Secondary rhinoplasty

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The tip more than likely can be de-rotated and the columella show can probably be improved upon. The recovery woould probably be similar to your first rhinoplasty.

Secondary Rhinoplasty

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An upturned or short nose can be somewhat difficult to treat and may require cartilage grafts to push the nasal tip down. Secondary rhinoplasty can be complex and you should clearly seek the services of an experienced rhinoplasty surgeon.

Correcting hanging columella and upturned nose tip

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The overly rotated nasal tip is a rather common complication of rhinoplasty with scar tissue pulling the tip up and over the lower edge of the cartilage nous septum. The side appearance can be improved by a little filler injection along the top of the nose (But this will not diminish visibility of the nostrils on frontal view).

A repair of this would require separation of the lower lateral cartilages from the septum (which is done when a hanging columella is narrowed anyway) and fixation of the tip in a lower, de-rotated more attractive location. (The operation is slightly more involved than a tip rhinoplasty but less complicated than a full rhinoplasty)

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

You may benefit from a Non-Surgical Rhinoplasty to lower your nostrils and add volume to your nose.

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If your nose isn't too large, you would be surprised how much better your nose could look after an Injectable Filler treatment. You should consult a board-certified specialist experienced in using fillers in the nose. You should also see many photos before proceeding.

Feel free to email me a full-facial frontal and profile photo, and I'll be happy to share my thoughts with you.

I've attached a link to my Non-Surgical Rhinoplasty photos for your perusal.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 429 reviews

Rhinoplasty Revision

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Hi Peony,

It is difficult to answer your question accurately without either examining your nose or having some photos to evaluate.

Most likely the procedure would involve cartilaginous grafts. Consult with a few experienced rhinoplasty surgeons, and then make your choice of surgeon carefully.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.