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

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.

Doctor Answers 6

Nose tip hangs down

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Dear anonymous121212,

Thank you for your clinical post and photographs. The previous rhinoplasty may have corrected some nasal bridge abnormalities and tip rejection, but you still have a hanging columella which is representative by an overly elongated bottom part of the partition cartilage called the septum. The caudal septum is still too long. You have some retracted nostrils particularly on one side with a lot of nostril show.

Revision rhinoplasty, including tip plasty and improvement in the caudal septum and the columellar alar relationships can be performed. Revision surgery in the Province of Ontario can range from $7,000.00 to $15,000.00 and is it is important that you seek out a cosmetic plastic surgeon or facial plastic surgeon with significant rhinoplasty experience. The use of computer imaging will also help determine the kinds of outcomes that you can achieve and having performed cosmetic rhinoplasty for over 20 years and being trained in both plastic surgery and ear, nose, throat, head and neck oncology I am confident in saying that you should be able to achieve a nice improvement in an already pleasing rhinoplasty result for yourself.

I hope this information is of some assistance and best of luck.

To find out more, please visit the link below.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

Toronto Plastic Surgeon
4.6 out of 5 stars 101 reviews

Revision rhinoplasty may be necessary to repair a hanging columella.

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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

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Tip revision

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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! 

Michael Yerukhim, MD
Cleveland Facial Plastic Surgeon

Revision Rhinoplasty for a Hanging Columella

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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.

Gary Motykie, MD
Los Angeles Plastic Surgeon
4.3 out of 5 stars 67 reviews

Rhinoplasty to reduce a hanging columella

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 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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Hanging columella: suggestions?

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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.

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.