Can I fix my hidden columella (where it attaches to upper lip at the subnasal) without grafts? Thanks.

Question

I've read that suturing the footplates and/or medial crura can advance the subnasale. Also, can this be fixed with a closed rhinoplasty?

Brian M. Harmych, MD, FACS · Answer

Thanks for sharing your questions and photographs. An experienced rhinoplasty surgeon should be able to address all of your concerns with a closed rhinoplasty. However, correction of the alar-columellar ratio problem ("hidden columella") would usually be done with a graft. There are several ways to accomplish this; septal extension grafting, as mentioned by others, would be one way. I'm not optimistic that simply suturing the medial crura would allow for adequate correction.

Reza Momeni, MD, FACS · Answer

Yes it's possible to accomplish this with a technique called septal extension grafting.  This is done just like a rhinoplasty, and it makes the columella appear just a bit longer than the alar wings, making the nose more harmonious.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a tip refining rhinoplasty which can also help increase columellar show.  Suturing the medial crural footplates can also be designed to push the columella forward.   Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Barry L. Eppley, MD, DMD · Answer

Increasing columellar show in any appreciable way is best done by placing cartilage grafts behind it. (septal extension graft) Driving out the unsupported medial footplates is what is needed to push the nasolabial junction forward.

Can I fix my hidden columella (where it attaches to upper lip at the subnasal) without grafts? Thanks.

Answers (4)

Answer: Columellar Show

Answer: Columellar Show

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Everything you need to know about Rhinoplasty

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Can I fix my hidden columella (where it attaches to upper lip at the subnasal) without grafts? Thanks.

Answers (4)

Answer: Columellar Show

Answer: Columellar Show

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.