Can A Revision Nose Surgery Correct Hanging Columella and Asymmetry?

i ve already done a nose job and now my nose count to left and have projected look and tip bossae and a hanging columella, what procedures can be done to correct these problems?

Doctor Answers 7

Columella and Nostril Issues After Primary Rhinoplasty

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Looking at your photos, I can appreciate the issues you are seeing in the lower one-third of your nose. In particular, your tip cartilage appears asymmetric along with your nostril openings - with your columella playing a direct role in this. In my opinion, you also have asymmetric alar retraction where the nostril rims appear to be scarred upward. Furthermore, there looks to be pinching of the nasal tip where the tip cartilage was presumably removed during the surgery. Collectively, these issues are drawing unwanted attention to the tip region. Whether or not you pursue a revision rhinoplasty is based on how much this appearance bothers you. Only you can assign a value to what it would mean to try and take corrective measures to reshape the nose further. The goal would be to create a nasal tip that is more symmetric with a gentle convexity extending out from the tip on both sides. This will likely require an open revision rhinoplasty approach along with cartilage grafting to rebuild and reshape the tip. In addition, you will probably need to have composite grafting from the ears in order to help bring the nostril rim down on both sides. You may also require fascia grafting as part of the procedure. Make sure you consult with a revision rhinoplasty expert if and when you eventually consider a secondary procedure. 

San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Revision nose surgery to correct hanging columella and asymmetry

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Nasal tip asymmetry is sometimes extremely difficult to repair from previous rhinoplasty surgery.  Bossa are typically addressed by shaving them down.  Alar retractions are typically dealt with by composite skin grafts taken from the ear.  A twisted nose will have to be addressed either through osteotomies and/or spreader grafts.  A hanging columella is a relatively easy fix by trimming back both the membranous and septal columella to create better alar columellar relationship.  This is usually done under a general anesthesia as a closed rhinoplasty.  

Can revision Rhinoplasty correct hanging columella?

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Yes, a Revision Rhinoplasty can correct a hanging columella however, from the front view it's not evident that you have a hanging columella.  Evaluation of this would require a profile view.  The columella normally has up to 5 mm's of show on the profile view.

Revision rhinoplasty

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You have some deviation and asymmetry. Revision rhinoplasty can correct this if it bothers you. See a surgeon with experience in this type of problem and view photos of other patients that he or she has done who have similar situations to yourself.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Revision rhinoplasty surgery for hanging columella and assymmetry

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Revision surgery would be appropriate for your findings.  That does not mean you have to have one.  But if you are unhappy with the shape of your tip, then a revision rhinoplasty can improve the symmetry and balance of the tip.

Revision surgery for tip asymmetry and columellar show

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Yes, revision rhinoplasty is an option for improving the concerns you mentioned. This involves complex reconstruction of the area to rebuild the support and symmetry of the tip. The columellar show can typically be improved in addition to the alar retraction.

I would consult with an experienced revision rhinoplasty surgeon to explore what specific options you have.

Crooked tip

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Looking at your photos it seems there's some asymmetry to the nasal tip cartilages and possible displacement of cartilage grafts placed at the time of surgery with the superimposed contribution from scar tissue formed after surgery.  Revision rhinoplasty can help correct these things but to know for sure I would visit a rhinoplasty specialist who can examine your nose and educate you about the things that can be corrected and the things he may not be able to correct.  Having the previous operative reports are also helpful to see what was done.  The best person to do the revision rhinoplasty would be your previous surgeon as he knows what was done and what to expect as he does the surgery.  The hanging columella can be secondary to excess mucosa lining, skin, or septal cartilage all of which can be addressed at the same time as the above.

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.