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

Yes, a hanging columella can be treated with a closed approach, though an open approach can also be used if that's the surgeon's preference. I have found good success in treating an isolated hanging columella using the closed approach.

The hanging columella can be caused by an excessively long septum in that area. Some will treat the problem by trimming the septum. I've also treated the problem by using what's called a tongue-in-groove technique where the cartilage making up the columella is setback and overlapped onto the septum. This can create a more stable and secure nasal structure.

What you have is called a hanging columella. It is usually seen after rhinoplasty in which the lower (caudal) portion of the septum is left too long. Often the septum protrudes into one of the nostrils. Surgical treatment can range from simple to complex. I respect the excess cartilage and nasal lining. Some surgeons will address this with cartilage grafts, but this often makes the problem worse. The correction can usually be accomplished with 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

A "hanging columella" is noted when the central portion of the nose (between the nostrils) hangs more than 2-3mm below the nasal rim. This condition can be due to an elongated septum or large nasal spine. In either case, it is relatively easy to fix this without performing an incision across the columella (open rhinoplasty). This procedure could potentially be done under local anesthesia. The surgery would involve partial removal of the anterior septum or nasal spine and partial resection of the mucous membrane.

Hi Miami3816,

Yes, a hanging columella may treated via an endonasal or closed rhinoplasty. Hanging columella may be due to several factors such as excess tip cartilage, excess membrane tissue, excess septum, or excess bone. Rhinoplasty via an endonasal approach does not leave any external scars and generally has less swelling the open rhinoplasty approach.

However, more important that the specific approach, open or closed, is the specific maneuvers during the rhinoplasty surgery. Both rhinoplasty approaches are good, and the incision after open rhinoplasty is typically not noticeable. Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate option for you. Best of luck.

Dr. Chaboki

The hanging columella is a condition which can usually be corrected  via a closed rhinoplasty approach.  Although different situations may lead to excess columellar show, a common cause of hanging columella is excess caudal septum.  The septum is the cartilage and boney wall which separates the nostrils.  If there is excess caudal septum, the cartilage can cause the columella to protrude.  The septum can be shaves with a closed rhinoplasty technique, and can then be reset between the medial crura to allow for less columellar show.  Good  Luck, Dr. Corrado

A hanging columella is when the area between the two nostrils hangs downward showing too much skin on profile. This can also make a nose look too long. According to the medical literature, the columella should not hang more than 2 to 4 millimeters below the edge of the nostrils when viewed on profile. There are a number of ways to treat or reduce a hanging columella, the technique used really depends on the actual cause; which can vary.

I treat hanging columellas through and endo-nasal or closed approach, since I perform over 90% of my primary rhinoplasties closed as well.

I read your concern and reviewed your photo. The best way to repair a hanging columella is to determine the cause. It may be due to your septum being too long. I suspect, in your case, the exaggerated curvature of your columella will require division of your lower lateral cartilages to straighten the medial crurae. You might also benefit from a columella-strut, cartilage graft for additional straightening. In my practice, an open approach would be used.

I hope this is helpful for you.