My nose tip or columella hangs down. Any suggestions? (photos)
Doctor Answers 6
Nose tip hangs down
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.
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R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Revision rhinoplasty may be necessary to repair a hanging columella.
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.
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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.
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