Hanging alar and retracted columella. What procedures are needed to get the maximum result? (Photo)

Question

I have flat and wide nose with hanging alar + retracted columella. What are the procedures needed in order for me to get the maximum result ?

Jacob Tower, MD · Answer

Hello, hope you are well. There are many options to consider for your nose. A septal extension will effectively increase your columellar show and correct the issue with retraction. SMAS debulking, refinement tip-plasty, and conservative dorsal augmentation should also be considered to create a narrower appearance. These maneuvers will make your nose look less flat and wide, and the increase definition of the tip.
Best,Dr. Tower

Donald B. Yoo, MD, FACS · Answer

Hi purrfeccat

To achieve an enhanced relationship between your columella and your ala, one very effective approach would be to create more columellar show by using a septal extension graft (crafted from either your septal or rib cartilage) to create more projection of the base of your nose and columella. The ala have a somewhat hanging shape due to their width and curvature. These aspects could be improved with alarplasty using alar rim grafts in addition to alar base reduction incisions to create slimmer, straighter and less "hanging" of the ala.

Bora Ok, MD · Answer

Hi from Istanbul! In your case, I'd recommend a septal extension graft to supporting the tip and alar rim graft to slightly elevate the columellar base, which will improve retraction. Then, alarplasty can be performed to fix the hanging alas. Best of luck on your journey!

Lexie Wang, MD · Answer

Hi purrfeccat. I'm going to assume that this is a primary rhinoplasty, meaning you have not had any procedures on your nose. If that is the case, and the above are you only concerns (hanging ala, retracted columella), you most likely need a septal extension graft to push out the columella and I would do Weir incisions to address the ala. Good luck!

Man Koon Suh, MD · Answer

You require corrective surgery to address nasal bridge augmentation, tip projection, and columella projection. While you may have noticed a hanging alar appearance, this seems to be a result of a retruded columella rather than actual hanging ala. It is anticipated that the hanging alar appearance will resolve following the correction of tip projection and the retruded columella.

The most effective surgical approach to simultaneously correct tip projection and the retruded columella is to utilize a septal extension graft constructed from septal cartilage. Nevertheless, because septal cartilage in Asian noses tends to be small and fragile, combining it with ear cartilage often yields significantly better outcomes in most cases.

Tanveer Janjua, MD · Answer

Alarplasty is a very fine and quick procedure that can narrow the nostrils and reduce the flare to soften the appearance. It has other names as well like ‘Weir Excisions’ or ‘Nostril Reduction’. However, it is important to note that asymmetry of nostrils is common and cannot be corrected with alarplasty. Visit the alarplasty website to learn all about it.
Click on the video link below to see the details.
For the retracted columella a piece of cartilage from the septum or ear can be used to push it out.
Regards
Dr. J

Hanging alar and retracted columella. What procedures are needed to get the maximum result? (Photo)

Answers (6)

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