Retracted columella - help me. Revision surgery. What can fix my nose? (Photo)

 Nasal tip has a very delicate balance between the Alar margin and the columella. Whenever the columella is retracted it gives the appearance of a hanging ala. Whenever the Ala is retracted it gives the appearance of columellar hanging. There should be a general 2 to 4 mm distance between the inferior edge of the Alar margin and the columella. Building the columella proposes somewhat of a challenge but generally speaking The columellar length and height need to be improved upon with cartilage grafting. Many of these excellent success in doing this. The other issue that you need to contend with is by building the height of the columella and improving upon the show, the nose will lengthen somewhat. There's a delicate balance between the Alar columellar relationship and the length of the nose. Please make sure that you consult with a double board-certified facial plastic and reconstructive surgeon for this very specialized form of rhinoplasty. 

Adding cartilage to your columella will help "push" the columella down and fix the retracted position of it. The new columella position will also have the effect of making your ala appear in a more appropriate position. I would bet that the hanging ala appearance will disappear after the columella is fixed. Of course you need an in person examination to look at the static and dynamic positions of your nose.hope this helped!

I am confident that your nose could be improved with a combination of cartilage grafting, and lifting the ala, but the extent of improvement could only be determined with a direct examination. Cartilage can usually be obtained from the nose even in patients with previous rhinoplasty, but again examination and more information about what was done previously would be necessary.

Without having had the honor of examining you, and provided there is enough tissue left from your prior procedures, you should be able to undergo a reconstruction (revision rhinoplasty) that makes you happy with your final result.