Do I need a columella lift and reduction? (photos)

Question

Is a columella lift/reduction what i need? How is the heeling process? I am.scared of swelling of nose tip. I had rhinoplasty 10 years ago and my swelling didnt go.for about 5 years... 2 years ago is is done a lip lift procedure. Which I believe had influence of dropping columella.

Alejandro Nogueira, MD · Answer

Conceptually said the so-called hanging columella does not exist, it is a myth (except in elder patients); a columella may be exposed, be too visible and the caudal septum mucosa be exposed due to a series of factores, suitable to different corrections:
-seems you have alar rim retraction, could be a postop sequel of your rhinoplasty or maybe the rhinoplasty did aggravate a pre-existant issue; this needs alar batten grafting as caudal extension vectors to push down the alar rims to a neutral position
-the lip lift was overcorrected thus leading to an excess of strain at the columella's base, clearly visible as a protrusion of the columellar base; this is a very uncommon complication since the columella is a very firm anchor point, so necessarily has to be caused by another factor: weakening of the medial cruras of the alar cartilages, which are the pillars underneath the columellar skin; this structural weakness may be, as well, preoperative and congenital aggravated by the rhinoplasty or a mere iatrogenically sourced; anyhow the solution is the same: the tongue-in-groove anchoring of the medial cruras to the (existant or built) caudal septum.
I strongly recommend you seek the services of a well experienced rhinoplasty surgeon; difficulty 7 out of 10 scale, surgical time 3 hours if only that problem has to be fixed.
If you wish better grounded opinion please do post or send privately well lit, focused and standard images: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

James Shire, MD · Answer

The appearance of your nose is the direct result of your prior rhinoplasty. The lower lateral cartilages have been overly reduced, causing lose of support of the nasal framework. This created retraction of your alas and prominent nostril show. This also gives the pseudo appearance of a hanging columella. The nasal tip is asymmetric with uneven and malposition domes adding to this appearance. These issues can be corrected and improved. Consult with an experienced expert in REVISION rhinoplasty.

Eric M. Joseph, MD · Answer

Your photos reveal excess nostril show on front view, and a straight columella and infratip lobule on profile. An examination may be necessary to determine what might be best for you moving forward. Some people benefit from nostril lowering with Silikon-1000, an off-label filler for permanent results. Hope this helps you. Dr Joseph

William Portuese, MD · Answer

The hanging columella can be reduced with a columella-plasty.  The tip of the nose can also be rotated downward a couple millimeters to help with the nostril show.

Shervin Naderi, MD, FACS · Answer

Hi.  The front view was not a good picture and it was taken as a selfie very close up with significant distortion.  We need much better photos.  The profile picture was slightly better but again we need full view of your face.  However based on these limited photos you do not simply have a "hanging columella."  You also have "alar retraction" as well as an over rotated and over projected tip.  These in combination are whats causing the aesthetic problem you seeing.  If you just elevate the columella then you will have a long upper lip.

Do I need a columella lift and reduction? (photos)

Answers (5)

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