How Much of the Floppy Skin Below the Columella Cartilage Can Be Removed? (photo)

My alar rims are high, and my columella is low. My nostril show is 10mm. I have been told that the alar rims can be lowered with cartilage from my ear, so that will help. But I wonder how high the columella can be lifted? I also have red spider veins at the nostril base. Can that part of the skin be removed during rhinoplasty?

Doctor Answers 9

Columellar show

The columellar show is an important issue that is addressed during rhinoplasty.  The columella can be trimmed 4-5 mm to reduce columellar show. Cartilage grafting and composite skin grafting to the nostril rim can bring the alar rim down to further reduce columellar show, with an added benefit to shortening the bottom half of the nose.  Any spider veins can be addressed with either cauterization or simple removal.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Columella show

You have too much of what we call columellar show.  It is easily corrected by removing cartilage and mucosa along the lower part of the septum.  You are absolutely correct in your assessment, yet many plastic surgeons fail to correct for a hanging columella.  It is one of the most frequent things that need to be done in secondary rhinoplasty and it works really well. Trying to lower the alar rim with a cartilage graft is much more difficult to get to work.  I'm on your side with the way you see this problem.And, trust me, it is easy to do and works well.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Hanging columella and alar show

Based on you photo it appears that you have extended caudal septum/ septal tension causing excessive columallar show and droopy tip.  The most conservative and least complicated procedure would be a caudal septal resection to reset the columella higher as well as reducing the spider veins. You must consult with a board certified facial plastic surgeon specializing in rhinoplasty. Good luck

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
4.9 out of 5 stars 204 reviews

Treating excessive columellar show

Thanks for your post and photographs. It's a little hard to say what the best approach would be to treat your columellar show based only on the photos you submitted. I do get a sense that you have a bit of a hanging columella that can be brought up to improve the alar columellar relationship. You can learn more about treating hanging columella at my link below.

If the alar rims need to be brought down this can be done using alar rim grafts or lower lateral cartilage repositioning.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Hanging columella with tension septum can be made dramatically better

Dear Gift2myself,


Thank you for your question and for posting your pictures. Based on your pictures we are not seeing a lot of alar notching so while alar rim grafts or composite grafts are often used to correct notching in the ala it really will not do anything for the sense of hanging columella.


In your particular case it looks like you have a bit of what is called a tension septum which causes the tip to push forward and down causing more nostril show. In our experience this can be made dramatically better by suturing the tip back to the tip- a tongue and groove procedure- to  correct much of this hang. Moreover by treating the tension septum and evaluating the shape and configuration of the tip cartilages themselves, this can all be mad much better without having to worry about being overly rotated (piggy tip) or having to great a space between your nose and lip.


Warm Regards,

Peyman Solieman, MD

Peyman Solieman, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Elevate the columella and lower the alar rim to create balance

There are surgical techniques to lower and alar rim and elevate or shorten the columella to enhance the nose appearance and create a more balanced nasal tip relationship. The photos that you provided are at a angle where it's difficult to fully assess the alar and columella relationship. Proper photo angles and a face to face consultation with your board certified plastic surgeon are your best options. The red spider veins are best treated with laser ablation.
Best Wishes,
Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

How Much of the Floppy Skin Below the Columella Cartilage Can Be Removed?

Your comments are very astute. Often, dealing with excess nostril show involves pushing down the alar margin with cartilage grafts and bringing the columella back. The combination typically results in significant improvement in the properly selected patient. With regard to the spider veins on your nose, these would likely be best treated with a laser or a small amount of cautery during your rhinoplasty. I hope this information is helpful.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Hanging columella surgery can be done several ways.

Hanging columella surgery can be done several ways. The amount of excess you have can be removed and the spider veins cauterized to give you what you want. The remainder of the rhinoplasty would be done depending on your desires after a consultation. Choose an experienced rhinoplasty surgeon. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Reshaping the Ala in #Rhinoplasty

It is difficult to appreciate the specifics from your photo, however a alar-columella relationship is very important to an attractive nose. You can elevate up the columella by removing cartilage or bone if needed and often the alar rims are lowered to help balance the overall appearance.

You should see a board certified plastic surgeon who has significant experience with rhinoplasty in your area to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.