Will a Columellar Tuck Help De-project Nose Tip?

Overall, I am happy with the rhinoplasty I had over a year ago. I had a very wide and high bridge that was narrowed and lowered, and my large round tip was refined and a columellar strut added. One thing I would like to get corrected is to lift/shorten the columella so that it doesn’t show as much. Will a columellar tuck also help de-project the tip a bit? How involved is this type of procedure? I included photos so you could see what my nose currently looks like. Thank you!

Doctor Answers 4

Columellar tuck helps de-project nose tip

Yes.  When tucking the columella inwards it will derotate and de-project the tip.  By trimming back the membrane and cartilage of the caudal septum, the entire nasal tip is de-projected.  Occasionally some adjustments in the nasal bridge will have to be performed as well.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Will a Columellar Tuck Help De-project Nose Tip?

Will a Columellar Tuck Help De-project Nose Tip?  No, a columellar tuck is recommended after looking at your photos but this is make the nasal tip appear less over-rotated and will have no effect on the tip projection (how far off the face the tip projects).  I have decreased tip projection with an incision through the mid columellar region which could be combined with the columellar tuck.  Your nasal bridge appears to be quite scooped and this certainly contributes to the problem.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Improving columellar show to deproject the nasal tip

The columellar show can be addressed though this won't necessarily change the tip projection. The tip projection can be reduced and the columellar show addressed at the same time if you want, though.

It is very important for you to clearly express your ultimate goals with your surgeon. Digital morphing in the office helps a lot with this discussion in my experience.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 21 reviews

Columellar Tuck and Deprojection of the Tip

The maneuvers required to perform a columellar tuck will not necessarily do anything to help deproject your nasal tip. While it is possible to perform both of these rhinoplasty maneuvers at the same time, they can also be done independently of one another.

Looking at the photos provided, I am not convinced that the columella is your main issue. In my opinion, your nasal tip projection is excessive, which is what I would focus on more as a revision rhinoplasty expert. Depending on how much change in projection you desire, the revision rhinoplasty may be less or more involved. In some ways, you may be able to get away with a limited closed revision rhinoplasty to help deproject the tip slightly. If you desire a more signficant change though, an open revision rhinoplasty is going to be indicated to ensure that the new position and shape of the tip is natural and balanced.

Good luck with this decision. Dr. Hilinski.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 40 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.