Columella/upper Lip Issues? (Photo)

Your photos show excess nasal spine and elongated septum. Your tip is inverted (and full) with nostril flare. Typical correction includes resection of nasal spine to reduce pull on upper lip, trimming of excess septal length, grafting the alar rims to reduce flaring, supporting the tip with grafting, and a conservative tip plasty-- to avoid creating more nostril flare! An experienced surgeon should be able to help you. Best, Dr. G.

You are correct in that you have a hanging columella. Typically, in an unoperated nose such as yours this is usually the result of an excessive nasal spine or excessive caudal or distal septal length. Since I do not have a base view of your nose, I cannot tell you exactly the likely cause. It is also causing you to have an obtuse nasocolumellar angle which makes your upper lip (white part) look too long and the tip itself hangs. This can be corrected during a rhinoplasty procedure and also you may need a septoplasty at the same time depending upon what I mentioned above especially if there are any concomitant breathing issues. I agree with you seeking a facial plastic surgeon for these issues. Good luck.

You have several issues apparent from your photos with your nasal tip, all of which can be effectively managed with a rhinoplasty.  The alar rim needs to be supported and lowered with cartilage grafting.  The nasal tip is also a bit wide and amorphous on anterior view, a problem corrected by sculpting and repositioning the lower lateral cartilages during rhinoplasty.  There are several possible reasons for the fullness at the lip/columellar junction which would be best diagnosed during a consultation.

A hanging columella can be addressed by trimming back both cartilage and skin from the inside of the nose.  In addition, the depressor septi ligament may be released to prevent the tip from drooping down upon smiling.  Any other tip adjustments can be performed at the same time to prevent the downward look of the tip itself.  This can all be done through endonasal techniques or closed rhinoplasty.  The rate of requiring a touchup in our practice is approximately 10%.

This is an issue that can definitely be addressed at the time of a rhinoplasty. As you search for a plastic surgeon, ensure those you consider are board certified and can show you examples of work they've done on similar cases. It's best to interview several surgeons before making a selection.

 

Good luck!

Dr. A

From your posted photos I am not so sure that you have a hanging columella because on front view the bottom of the columella is not too far below the level of back edge of the nostrils and on side view the bottom of the columella does not stick out far below the mid-nostril axis. I suspect the problem is mostly retraction of the outer rim of the nostrils. That can be corrected by repositioning the tip cartilages and in some cases by placing composite cartilage skin grafts between the nostril rim and the bottom edge of the tip cartilages.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Your issue can easily be addressed during rhinoplasty.  The upper lip is often connected to the columella by a depressor muscle.  This can result in a sense of an abnormally short upper lip or depression of the nose with movement of the lips.  This small muscle can be released, resulting in improvement in the hanging columella and improvement of the nasolabial (lip-to-nose) angle.  Although I prefer a closed approach (no external incisions), this can be performed either through open or closed rhinoplasty, depending on the surgeons experience.  It is important to consult a board-certified Plastic Surgeon who is very experienced in rhinoplasty with your concerns.Best wishes!

Your  hanging columella can be elevated and the fullness at the junction with the upper lip can be reduced. You also will need cartilage grafts to lower the elevated nostrils rims. All this can be achieved with rhinoplasty surgery.

Hi,

Yes it looks like the inferior part of your collumela juts out into your upper lip. This would have to be resected during a rhinoplasty to restore the natural balance of the lip collumela relationship. Your tip is also ptotic and needs some rotation,

Best,

Dr.S.