My Columella Shows, What is the Best Way to Treat It?

Dear Peter,

From the lateral views of your nose (the side profile), it appears that there is excessive columellar show mostly due to a hanging columella. There are two main components that can contribute to this:

-an excessively long or over developed septum (the firm midline cartilage)

-overdeveloped medial crura (the soft cartilages that define the shape of the columella

Both of these can be treated with a rhinoplasty focused on refining the columella. If you are pleased with the appearance of the rest of your nose, then this makes it even more straightforward, and I think it would be very reasonable to achieve the appearance you desire.

The base view of your nose (the one looking from below) shows some asymmetry of the medial crura (the cartilages that shape the columella) and this can be addressed at the same time.

I hope that helps.

Best wishes,

-Dr. Asaria
 

This does appear to be primarily due to excess caudal septum and could be manged by trimmin that area. If the medial crura did not retract up then you might need some "tongue in groove" fixation as well to set the alar columella ratio.  See how it looks on your whole face with computer imaging before to get a sense of the change.