Is It Common And/or Simple to Bring Down Columella?

Question

My surgeon says that he will bring down my columella slightly. Currently from the side you cannot really see my columella at all, which I don't like but previously didn't know WHAT I didn't like about it...it just looks rather unnatural. It will look MUCH better if it is slightly lower. Anyway, I can't seem to find any other cases where a patient had their columella brought down. Is this an uncommon thing to do?

Jonathan Kulbersh, MD · Answer

From the side, it is an elegant appearance to see 2-4 mm of the columella.  In patients that cannot see the columella from the side, it is either due to:

	1)  The columella is retracted or short

	2)  The nostril is low or hanging

	This can be corrected either surgically or non-surgically.

	 

	Surgically, to bring down the columella, I use a septal extension graft with a PDS plate.  This is medically terminology to bring down the columella by making the septum longer in the area.  If the nostrils are low or hanging, then they can made raised by removing a small amount of tissue inside of the nose.

	 

	The columella can be make lower non-surgically by placement of temporary injectable fillers.  The nostrils cannot be raised using non-surgical techniques

	 

	I hope this helps!

Ronald J. Edelson, MD · Answer

It is simpler to raise a columella that hangs down than to do the opposite which is what I think you are describing. Is this the result of previous surgery? To me, it doesn't seem like it's worth undergoing in either case, but it would be helpful to see photos.

Toby Mayer, MD · Answer

This is common in black noses and less so in Caucasians. Cartilage grafts or composite grafts are used to do this. I need photos to give u a better answer.

Nima Shemirani, MD · Answer

Dear maeby,

	
		Placing a graft in the columella will make it come lower
	
		There are also ways to lift the nostril to show more of the columella


	Best regards,

	Nima Shemirani

William Portuese, MD · Answer

It is much more common to bring the columella up than it is down. To bring the columella up trimming of the caudal septum of both cartilage and membrane is performed to trim back the columella. To give more columellar show, a cartilage graft is inserted in the columellar area from the septum to augment and bring forth the columella. This can easily be performed at the time of the rhinoplasty.

Barry L. Eppley, MD, DMD · Answer

It is not common to drop down the columella in many rhinoplasties, but it can be done by cartilage grafting. Several millimeters of increased columnellar profile can be obtained by either a septal extension graft or an interpositional medial footplate graft.

Jeffrey Zwiren, MD · Answer

A photograph would be very helpful in determining your specific nasal profile. If the columella is retracted then is is common to have a somewhat underprojected nasal tip or a drooping nasal tip. There are several surgical maneuvers that can be done to improve your nasal profile

Steven Wallach, MD · Answer

Not seeing the columella a bit in profile may be due to one of several reasons.  It is best to go for a consult to be properly evaluated.

David C. Mabrie, MD · Answer

I really like using fillers to increase the columella show from the profile. 
	
		The goal is to have 2-4 mm of show on profile.
	
		You can also ask your provider to do a test injection with saline to show you how it will look.

Is It Common And/or Simple to Bring Down Columella?

Answers (9)