It this a retracted columella or a tip rotation? Can I fix this will fillers in the columella? (photos)

You appear to have a retracted columella. The area may be too tight/firm for fillers to work but a revision rhinoplasty with cartilage graft can help.

Hello and thank you for your question. You have a tricky problem. It sounds like your biggest concerns are in the tip and columella. I also see asymmetry in the nostrils and what look like scars from alar base resections. Your issues are unfortunately due to scarring after rhinoplasty which can contract and distort the overlying tissues, such as the nasal tip and can cause some columellar retraction. This is why it is important to perform certain maneuvers during rhinoplasty surgery to prevent such scarring and retraction by reinforcing the underlying structural framework for the nose and tip. Given you've previously had a rhinoplasty, and there is no doubt extensive scar tissue present in your tip and alae, fillers would not be able to overcome the scarring, and only an open rhinoplasty can best address your issue.

In addition to addressing your aesthetic concerns, your septal cartilage (or an off-the-shelf alternative) would be harvested (removed) and turned into multiple cartilage grafts, which would then be secured into different areas of your nose for structural support, including in the columella (middle bottom portion of your nose between your nostrils) to really reinforce the tip and alae, and prevent recurrence of the alar retraction. As you've already had a rhinoplasty, likely your septal cartilage has been used already, so we'd use an off the shelf alternative (MTF cartilage).

The open approach is very effective in facilitating complex, precise maneuvers to refine the nasal shape and size to a particular aesthetic and look. Rhinoplasty is arguably the most difficult procedure to perform in all of plastic surgery. I would only recommend going to see a surgeon who feels very comfortable with both primary and revision rhinoplasty procedures, and who has significant training and experience in these types of surgeries. This is a surgery of millimeters, so if the surgeon you're going to only does 1-2 per month, you are not going to get the best result possible.

Of course it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from the photos and description provided.

Dr. Donald Groves, our expert facial plastic surgeon, has extensive training and experience with complex rhinoplasty surgeries, so I’d recommend for you to come see him (or another plastic surgeon who is extremely comfortable with rhinoplasties) for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) and type of anesthesia for your specific case. I hope this helps!

Dr. Emer

I agree that you appear to have a retracted columella on profile. You also have a curve in your columella as seen on the base view of your nose. That is causing slightly more nostril show on your left on front view. If you're looking to avoid further surgery, depending on your examination, microdroplet Silikon 1000 injections might be considered for lowering your retracted columella and for lowering your retracted left nostril margin for a more symmetrical nasal appearance. I hope this helps! Sincerely, Dr. Joseph