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

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

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.

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.

 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

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! 

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