Is my columella retracted? (Photos)

Question

I had a simultaneous double jaw surgery and septorhinoplasty in March (9 months post op). The aesthetic and functional result is overall great, but I don't like my lips. My philtrum looks too long from the front and side profile, and my lips are too protrusive/nasolabial angle is too obtuse. I'm looking to decrease the nasolabial angle to around ~95° if feasible and am willing to get a conservative lip lift (had maxillary downgrafting for more tooth show, so don't want a gummy smile) if my philtrum is also too long. If I do have a retracted columella, would a caudal septal graft, septal extension graft, or another procedure correct/normalize my nasolabial angle?

Donald Groves, MD · Answer

Hello and thank you for your question and pictures. You actually have a very difficult problem to correct- instead of a retracted columella, you actually have retracted nostrils causing a hanging columella and too much nostril show from the sides! Fortunately, a revision rhinoplasty can best address your aesthetic concerns and any functional issues with your nose. I would be able to adjust the size, shape, and especially the definition of your nose (particularly the tip and the nostrils). I'd also be able to open up and solidly reinforce the underlying structural framework of your nose (to prevent distortion and retraction from scarring forces over time)!

Revision rhinoplasty is truly a surgery of millimeters- they are the most technically challenging procedures in all of plastic surgery! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in revision rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading revision rhinoplasty experts (who performs 1,000+ nosejobs annually).

If you are unhappy with the appearance of your nose, I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with revision rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Eric M. Joseph, MD · Answer

Your second set of photographs appears to show excessive nostril show on profile. That is consistent with a hanging columella, or nostril retraction after previous septorhinoplasty surgery. Your philtrum and lips appear to look normal, in my opinion. If you have specific questions regarding your surgery, it may be reasonable to address these with your surgeon. Wishing you all moving forward. Sincerely, Dr Joseph

Is my columella retracted? (Photos)

Answers (2)

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