My nose tip or columella hangs down. Any suggestions? (photos)

Question

My nose tip or columella hangs down and I want to know if there is a way to shrink down the base of the tip or top of the columella. I say both because I'm not sure what should be done to reduce the droop. What is the recovery time on this procedure and an normal cost for this procedure in Ontario, Canada? I had a rhinoplasty and results are great but he said he doesn't touch nostrils or the columella. Thanks.

Eric M. Joseph, MD · Answer

In general, revision rhinoplasty techniques may be employed to lift a droopy nasal tip, and repair a hanging columella. If your surgeon is not familiar with such techniques, consider getting a second opinion from another rhinoplasty specialist. Thank you.Dr Joseph

Thomas A. Mustoe, MD, FACS · Answer

Lacking a profile picture that would be helpful in evaluation I agree that you have a hanging columella, but also fairly high arched nostrils which may be higher after your rhinoplasty ( can occur after cartilage resection from the tip cartilages). The best approach could only be determined on physical exam but often patients can benefit from a resection of the caudal septum and some mucosa, which is a minor office procedure.  In other patients a more complex revision tip rhinoplasty is necessary.   I would seek the opinion of a surgeon experienced in revision rhinoplasty since your surgeon does not want to perform a revision.

Gary Motykie, MD · Answer

Although a profile view of your nose would be very helpful in your evaluation, it appears that your caudal septum is still too long and you have retracted/arched nostrils with a lot of nostril show.  The best approach could only be determined on physical exam but often patients can benefit from a partial resection of the caudal septum and a revision tip rhinoplasty.   I would seek the opinion of a surgeon experienced in revision rhinoplasty.

William Portuese, MD · Answer

A hanging columella can be addressed by trimming back excess skin and cartilage on both sides of the nostrils. It's also important to release the depressor septi ligament which pulls the tip down when smiling and makes the hanging columella worse. For more information and many examples, please see  the link and the video below

Michael Yerukhim, MD · Answer

Thank you for your question and I'm sorry you're having issues. I recommend starting with an in-person consultation with an experienced surgeon, so that the structures can be properly evaluated. From the pictures you provided, it's very hard for me to tell the relationships of the relevant cartilages. Although, It seems like the tip needs to be elevated. I would recommend cutting the depressor muscle that pulls in the tip when you smile. You may benefit from reducing the nostril width. Seek an experienced revision rhinoplasty surgeon. Good luck!

My nose tip or columella hangs down. Any suggestions? (photos)

Answers (6)