Is It Possible to Correct a Hanging Columella with a Closed Rhinoplasty?

Most people focus on the hanging columella, which can easily be treated with a closed technique. It is important to look at the curve of the nostril. As we age, the cartilage softens and the rim of the nostril begins to retract, showing more of the columella. This process is often accelerated as portions of the upper cartilage is removed during a rhinoplasty to narrow the tip. For this reason I will commonly place a small piece of cartilage from the septum along the rim of the nostril to slow this process down. This graft is commonly called a batton graft.

Hello,

Although the hanging columella may be caused by many different anatomical variations, yours appears to be due to the cartilages that involve your entire nasal tip, known as the 'lower lateral cartilages'.  In your situation, you have an accentuated curvature of the part of the cartilages below the tip but are also affecting the tip as well. 

Proper treatment for your cartilage would involve using internal sutures to rebend the cartilage complex into a more pleasing shape.  Usually, an cartilage graft is utilized as well, called a 'strut' to reinforce the suture work and stabilize the cartilages.   It is true that this can be done with a closed rhinoplasty, but it would still require extensive internal manipulation and incisions to visualize and expose the tip cartilages.  Although many surgeons might argue that they can do it closed, no one would disagree that open rhinoplasty is technically easier and provides the best visualization and access to address the problem.

Best of luck to you!

Hello,

It is possible to elevate the columella with a tongue and groove in a closed procedure.  A nylon suture to the septum will elevate the columella. 

Dr. Nassif