Hangin Columella on one side - are there non invasive ways to fix the other side? (Photos)

Question

Hi! I had a nose job 9 years ago and I was left with one side looking like it’s hanging. the side that does not hang is my favorite and I’d like the other side to look the same. Is there any non invas ways to fix this situation. PDO threds, filler, Botox?

Donald Groves, MD · Answer

Hello and thank you for your question and pictures. You actually have a very difficult problem to correct- asymmetric retracted nostrils and a hanging columella on one side after prior surgery! Unfortunately, non-invasive options or even a minimal procedure or revision surgery "just to the tip" will not be able to fix your issues- any surgeon that tells you otherwise is either inexperienced or is intentionally doing you a huge disservice. A revision rhinoplasty can best address your aesthetic concerns and any functional issues with your nose. I would be able to release all the scar tissue present, then adjust the size, shape, and improve the symmetry and retraction of your nose (particularly the tip, columella, and 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

Lucian Ion, FRCS · Answer

Thank you for your enquiry and for sharing your photographs. On frontal view, the images suggest that the left nasal tip cartilage sits higher than the right, leading to greater retraction of the left nostril. This results in increased lateral exposure of the columella and gives the impression of columellar overhang, although this is not evident on profile view.

Unfortunately, non-surgical options are unlikely to achieve the degree of correction you are seeking. Injectable filler can sometimes offer a degree of improvement, but this is typically at the expense of making the nasal tip appear slightly fuller. That said, it is a reversible option and may be considered as a way of assessing whether a subtle change is acceptable to you.

In selected cases, botulinum toxin to the left nostril may be helpful if there is active elevation of the nostril during facial expression. If no such dynamic component is present, botulinum toxin would be unlikely to provide a meaningful benefit.

Eric M. Joseph, MD · Answer

If there is excessive nostril show on one or both sides, after rhinoplasty surgery, an office based procedure, with local anesthetic, may be considered to excise the visible nasal mucosa, and to lift the columella at the same time and suture it to the bottom of the nasal septum. You may not require a formal revision rhinoplasty surgery. I hope this helps! Sincerely, Dr Joseph

Mark Beaty, MD · Answer

From your description, it sounds less like one side is “hanging” and more like there is asymmetry, with one nostril sitting higher and the columella appearing lower on the opposite side. This is a fairly common concern after rhinoplasty and often becomes more noticeable over time.

Unfortunately, non-surgical options such as filler, PDO threads, or Botox are unlikely to provide a reliable or lasting solution in this situation. These treatments cannot adequately correct structural asymmetry or support issues involving cartilage and soft tissue.

The most effective and predictable way to address this concern would be a revision rhinoplasty, which typically involves precise cartilage grafting and tissue reshaping to restore symmetry and support.
I would recommend consulting with a double board-certified facial plastic surgeon who has extensive experience specifically in revision rhinoplasty.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can understand your question non-invasive methods will not provide permanent and accurate results. We never recommend having filler procedures done on your nose. Instead, I recommend revision surgery as the most permanent and safe method for you.
It would be better face to face consultation.
Best Regards!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, the best way to fix this is with a surgical revision. Support with cartilage grafts needs to be established and noninvasive ways such as thread lift or Botox would never work for this. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Ronald J. Edelson, MD · Answer

A hanging columella is not uncommon after rhinoplasty if the surgeon doesn’t shorten the cartilage which is dragging the tip down.,it is a straightforward fix but dues require some surgery

Zoran Potparic, MD · Answer

It is very difficult to make a clear conclusion based on these photos? It appears that your nostril is slightly retracted on that side which makes columella more visible? Not sure. Injection of filler may be the way to correct this minimal asymmetry. Good luck.

Sean Fisher, MD · Answer

Based on your provided photos, it appears that the true issue is alar retraction rather than the position of your columella. This can occur after rhinoplasty if the lower cartilages that make up the nasal tip are not supported adequately, are over-resected, or the rim is not supported. It is possible that columellar asymmetry can occur too depending on the techniques previously used (such as suture techniques, cartilage grafts etc). The only true way of addressing alar retraction is by undergoing a revision rhinoplasty. During this operation, the lower cartilages often need to be re-positioned and cartilage grafts used to strengthen the rim. I would recommend finding a well-trained plastic surgeon or facial plastic surgery with special focus in rhinoplasty surgery to come up with a surgical plan that fits your goals. 
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

Hangin Columella on one side - are there non invasive ways to fix the other side? (Photos)

Answers (9)

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