Does Lifting or Retracting the Hanging Columella (Only) Result In a Shorter Nose Tip or Tip Projection? (photo)

Question

Does lifting or retracting the hanging columella (only) result in a shorter nose tip or nose projection?

Mario J. Imola, MD, DDS · Answer

Excessive columellar show can have 2 underlying causes:  1) An overly long columella (comprised of both the caudal septum straddled by the medial crus of both lower lateral cartilages) and 2) Alar margin retraction (nostril rims).  One or the other or both of these factors can be contributing to the problem.   There are different ways to correct excessive columellar show and each will have its own unique impact on tip and nasal base aesthetics as described below.

	Correction of excessive columellar show, therefore, can be performed in one of 2 ways:  1) Resecting a segment of the caudal edge of the septum and raising the medial footplates of the lower lateral cartilages superiorly.   Depending on the shape of the cartilage resection from the caudal margin of the septum, the impact on the columella-lip relationship and nasal tip aesthetics will vary.  If the resection is performed with the majority of cartilage removal near the base of the columella (posterior columellar angle) then the effect will be to decrease the columella-lip angle giving the illusion of more downward tip rotation even though there will be essentially no change in the tip position.  If the septum resection is such that more is removed near the tip (anterior septal angle) then the effect will be to increase the columella-lip angle and result in a modest upward rotation of the tip.  This will also decrease the length of the nose slightly but have no impact on tip projection.  If the resection is equal at both the anterior and posterior septal angles then there will be very little or no impact on the columella-labial angle and tip rotation.  2) The second way to reduce excessive columellar show is to place cartilage grafts along the nostril rims (alar rim grafts).  This will have no effect on the nasal tip.

	Although the pictures you provided are not ideal, it would appear that in your case the main problem is that the columella is overly long and to a lesser degree there is mild nostril retraction.  It would be best for you to discuss correcting this with  one or more of the options above and use simulation imaging to see what suits your desires best.

Sam Naficy, MD, FACS · Answer

Depending on how the hanging columella is dealt with, tip projection can be reduced, maintained (kept the same) or increased

Ronald J. Edelson, MD · Answer

A hanging columella can be corrected either alone or in combination with shortening the nose. To shorten the nose as well. More of the columellar cartilage would be removed  at. The tip and also redundant mucosa also removed. In either event the procedure is less involved and works better using the closed rhinoplasty technique, in my opinion. The procedure takes about one half hour and the recovery quite easy with no bruising , that is unless you have other things done to the nose at the same time.

Toby Mayer, MD · Answer

Hanging columella surgery can be done several ways. You can lift the columella and only do that. You could increase or decrease the tip projection as well as shorten the nose.

Steven Wallach, MD · Answer

Lifitng the hanging columella does not have to impact the tip directly.  The tip can be treated in different ways separately from the columella.

Does Lifting or Retracting the Hanging Columella (Only) Result In a Shorter Nose Tip or Tip Projection? (photo)

Answers (9)

Answer: Hanging columella surgery can be done several ways.

Answer: Hanging columella surgery can be done several ways.

Answer: Hanging columella

Answer: Hanging columella

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Does Lifting or Retracting the Hanging Columella (Only) Result In a Shorter Nose Tip or Tip Projection? (photo)

Answers (9)

Answer: Hanging columella surgery can be done several ways.

Answer: Hanging columella surgery can be done several ways.

Answer: Hanging columella

Answer: Hanging columella

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.