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

I have a "hanging columella" and never under went any procedure on my nose. i' m ok with my tip but my nostrils shows a lot on the side, my nose looks longer than it is but even if i am very unhappy with it i' m afraid to go through the next step surgery just because i don t know how complicated the intervention is and if it needs to be an opened rhinoplasty. Thank you!

Doctor Answers 20

Treating a hanging columella

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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.

Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Treating Hanging Columella with Endonasal (Closed) Rhinoplasty

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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

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Hanging columella

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Yes! A hanging columella can be corrected with a closed approach.  However, if you are concerned about the degree of your columella that shows, you and your surgeon must determine if the columella show is due to elongation of the columella or retracted ala.  This is vitally important to determine the corrective steps that must be undertaken to correct this problem.  I recommend consultation with an experienced rhinoplasty surgeon to evaluate the nose and determine what measures should be taken.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

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A hanging columella is easily corrected with a closed rhinoplasty.

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A hanging columella can be easily corrected via the "closed" approach utilizing bilateral rim incisions that are virtually invisible once healed.  It can be done under a local anesthesia without difficulty.

Kevin F. Hagan, MD (retired)
Nashville Plastic Surgeon

Hanging columella can be corrected by closed rhinoplasty

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Trimming the membranous cartilaginous caudal septum can reduce the columellar show. This can be done quite easily through a closed rhinoplasty and is performed quite frequently in our practice.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Hanging Columella

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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!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

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

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First thanks for posting a photo. Yes in the closed rhinoplasty correction of the hanging columella can be done. See at least 3 opinions in person from boarded surgeons in MIAMI. Dr. Darryl J. Blinski

Treatment of the hanging columella

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The hanging columella can be due to the caudal septum protruding, to wide lower lateral cartilages, to a hanging tip, to malposition of the alar bases, or to a combination of all of the above.

Depending on the combination of problems, an open or closed rhinoplasty may be necessary.

For simple versions of this problem, a closed rhinoplasty may certainly be sufficient.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

How to Correct Hanging Columella

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Dear rhinoplasty patient from Miami,
I reviewed your nasal picture. If hanging columella is what you’re concerned with, I would recommend a columallar elevation. This can be done by caudal septum (bottom of septum) resection and reattaching the columella to the septum. This procedure can be done in office setting with local anesthesia

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 224 reviews

Tip and hanging columella go hand in hand

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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.

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 35 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.