Is there any way to lift the bottom of my nose (septum) as it hangs really low?

Question

The cartilage between the nostrils is lower than ala and apex of the nose. It is much worse when I smile, as it droops even lower. is there a way to lift it so its higher, and to make my nose droop less when I smile?

Jacqueline T. Cheng, MD · Answer

There is no substitute for an in-person examination, so I recommend that you schedule a consultation with a board certified facial plastic surgeon. They can examine your nose and offer solutions for refining the tip and giving you the beautiful, natural-looking nose you desire. Best of luck! 
 - Jacqueline T. Cheng

Rod J. Rohrich, MD · Answer

I believe you can achieve the outcome you want with your nose based on your description.  However, you need to consult in person with a rhinoplasty expert so they can see your nasal movement when you animate.  Be sure to consult with a board certified plastic surgery or otolaryngologist that has experience and expertise in rhinoplasty surgery.  Ask to see before and after photos of their own patients.

Thomas A. Lamperti, MD · Answer

Your descriptions sounds like you have a hanging columella. If this is the case then there are ways of tucking the area up and making the tip less mobile with smiling.You should visit with a rhinoplasty expert to see what your specific treatment options are.You can learn more about hanging columella treatment at my web reference link below.

Nima Shemirani, MD · Answer

Dear John,Yes, you can use cartilage grafting and/or sutures that can lift the tip cartilages of the columella and suture it to the septumThis will keep your nose from drooping when you smile and make the nose look better from the frontal viewWhen you are ready, please visit a rhinoplasty specialist who can address your concernsBest regards,
  
Dr. Nima
  
Member, American Academy of Facial Plastic and Reconstructive Surgery
  
Board Certified Facial Plastic Surgeon
  
Board Certified in Head and Neck Surgery

Zoran Potparic, MD · Answer

There are several ways to address deformity of the nose dominated by hanging columella. However, without good series of photos and/or in person evaluation it would be difficult to recommend  best procedure for you. A consultation with a board certified plastic surgeon with  good reputation in rhinoplasty is recommended. Good luck.

Thomas Trevisani, MD · Answer

Without photos and the benefit of physical exam- it's difficult to give the best answer.Generally speaking, Rhinoplasty can improve  and address all of the elements of the nose

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. A hanging columella can be fixed with a caudal septal trim during rhinoplasty. Based on your description, you may also benefit from a cephalic rotation of your tip to turn up your tip slightly and a columellar strut graft to add tip support to prevent drooping. 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. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon. I recommend that you seek consultation with a qualified board-certified plastic surgeon or facial plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

David J. Kiener, MD · Answer

- Excessive length of the cartilage of your nasal septum is a common issue we see often. It can be protruding on one side and be in the mid-line. This is a relatively easy issue to improve with surgery. You may also have some other issues such as nasal obstruction due to septal deflection further inside your nose, or other deformities of the appearance of your nose that you would like improved. I would suggest seeing a surgeon or two for their suggestions. Without an examination or photo it is difficult to give you specific recommendations.
  
  Thank you for your excellent question.

Tim Sayed, MD, MBA, FACS · Answer

It would help to see full facial photos (front and sides), but yes, refinement of the hanging or low tip is possible even if you're happy with your dorsum (the slope part). Assessment of the nose includes examination of the cartilage and bones, frontal/base/side views, intranasal exam (inside the nostrils to look at the septum), and evaluation for symmetry. Sometimes releasing the depressor nasi septi muscle helps rotate the tip upward slightly so that it does not plunge with smiling. Care must be paid to avoiding overtreatment since you like your nose in repose. We use Crisalix simulation software to help guide the discussion, as it lets you see a 3D model of your face with potential surgical changes applied. Go on some consults with board-certified plastic surgeons and/or ENT surgeons with facial cosmetic expertise.

Johnson C. Lee, MD · Answer

It sounds like you have a hanging columella. This can be fixed with a septorhinoplasty so that the area is lifted and your tip is made secure so that it does not droop when you smile. An in-office examination will help best determine which technique is best for your particular case so you can also have a better idea of what the end result will be.  Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Is there any way to lift the bottom of my nose (septum) as it hangs really low?

Answers (19)

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