Bad Rhinosplasty, Now Hanging Columella and Large Nostrils- Suggestions?

27 year old Navy Vet here who was "lucky" enough to get free rhinoplasty from the military for my "deviated septum." Now one side of my nose is weak and collapses when I breath and my nostrils seam a lot larger than they once were. I could really use some advise, or maybe it's just this damn OC life getting to me. Thanks guys

Doctor Answers 10

Hanging Columella and Large Nostrils after Rhinoplasty

Your hanging columella can be raised and the nostril rims lowered with alar rim cartilage grafts. This will improve the shape and decrease the apparent size of your nostrils. The mid-portion of your nose is narrow and probably is the area that you describe as "collapsing" can be corrected with placement of cartilage as "spreader" grafts which will strengthen the nose and improve breathing. Your problems are frequently seen in patients who need a revision rhinoplasty, but all can be corrected.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Rhinoplasty revision

From your photos,MIT seems like you would benefit from shortening the nose and correction of the hanging columella by respecting a portion of cartilage from the lower part of the septum (we call this the caudal septum).  This ismamafirly simple procedure and would improve the appearance greatly. I would accomplish this using the closed rhinoplasty approach.  the cause of your nasal obstruction requires  an examination to determine its cause and possible solutions.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Unhappy after rhinoplasty

  1. If it seems to good to be true...
  2. You get what you pay for

Well, we've all heard those before and unfortunately it often is. 

You seem to have bilateral alar notching based on your photographs, but a face-to-face interview and examination with a Board Certified Plastic Surgeon who emphasizes in Rhinoplasty would be best for you. It is important to know what was done to correct your deviated septum. Specifically, do you have septal cartilage available to lend support to your alae? Bilateral Lateral Crural Strut Grafts seem the most plausible solution based on your photos, but the exam would reveal the most. 

William A. Wallace, MD, FACS
Jacksonville Plastic Surgeon
4.8 out of 5 stars 45 reviews

Revision rhinoplasty

It looks from yoru profile more of alar notching which may or may not benefit from grafting to the alar rims for support.  An exam is key to evlauate this as well as your collapse that you are talking about.  You have to give it time to heal if it is less than one year since your surgery.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Rhinoplasty revision

Your posted photos show a notched nostril rim at least on the right, asymmetric tip cartilages, a c-shaped septal deviation concave to the right and a tip that projects forward more than 2/3 of the bridge length. I suspect what you perceive as a hanging columella is more nostril rim notching than it is hanging columella. If you document airway collapse with breathing at least part of your revision surgery would be covered by your health insurance.

You should get a copy of your original surgery report for prospective surgeons to review at consultation. You situation is complex so you should see more than one surgeon before deciding what to do. You are likely going to need revision of the entire procedure including septoplasty and multiple cartilage grafts to prevent collapse of the airway when breathing. Tread carefully going forward because your best chance is with a good first revision.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Revision Rhinoplasty

The first step for revision rhinoplasty would be to obtain a physical examination and a good set of photographs. Loss of nasal support would be addressed by restoration of the support if necessary with cartilage grafts. The Hanging columella would require resection of the caudal septum.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 14 reviews

Nostril show and alar collapse following rhinoplasty.

Excessive nostril show following rhinoplasty typically results from excessive resection of the lateral crus of the lower lateral cartilage.  The lower lateral cartilages provide support and are the major determinants of nostril shape.  Over resection of the lateral crus of the lower lateral cartilages can result in lost support leading to collapse and obstruction during breathing.  In addition the nostril margins can retract superiorly resulting in alar margin retraction and increased nostril show.  Revision rhinoplasty to improve these problems is possible with the use of cartilage grafts.  Specifically, alar margin grafts and lateral crural onlay or batten grafts can be used to help correct the problems you have described.

Mario J. Imola, MD, DDS, FRCSC.


Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.8 out of 5 stars 117 reviews

Sometimes nostrils look larger after rhinoplasty, which is really from weakening of the tip cartilages

A number of patients come in for revision rhinoplasty with nostrils that have become wider as well as weaker after prior surgery. This is often a result of loss of nostril support. By having too much cartilage removed and/or weak cartilages to start with, the nostrils pull upward causing what we call rim retraction.

The best way to treat weak, flared nostrils from prior surgery is to restore strength and structure with cartilage grafts. The best source for these grafts is your own septum. If the nasal septal cartilage has been operated on already, sometimes we use cartilage from your ear.

The bottom line is, a specialist in revision rhinoplasty can often improve both the function and appearance of your nose with the same surgical manuvers.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 126 reviews

Correction of retracted and collapsed nostrils

First off, a heartfelt thanks for your service to our country! As for your nose, it appears from your photos that your tip cartilages (lower lateral cartilages) have lost support, perhaps from being over-resected. This can result in retraction of the nostril rims and collapse of the external valves of the nose

Correction of this problem involves replacing the structural support of these tip cartilages. This can be done by taking stronger pieces of cartilage from the septum and placing them underneath the tip cartilages, creating what are called lateral crural strut grafts. These can be placed in such a way that they push the nostril rims downward, so that there is less nostril visibility from the side. Rim grafts or composite grafts (taken from the ear) could also be necessary, depending on the degree of retraction. The infratip and hanging columella can also be straightened by placement of a piece of cartilage between the medial crura of the tip cartilages, a graft called a columellar strut or c-strut. This will further reduce the amount of visible nostril.  

The best advice I can offer is that you seek a consultation with a surgeon who specializes in revision rhinoplasty. Make sure he or she understands your concerns thoroughly and can show examples of having corrected these issues for other patients. 

Best regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Hanging Columella and Large Nostrils

Based on your photos it appears that you have alar retraction as the main cause of your nostril show. This requires cartilage grafting to fix.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 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.