Hanging columella uneven on each side. What can be done? (Photo)

Question

I had an open rhinoplasty 8 months ago. I'm fairly happy, as my nose is much smaller. However, my my tip is wide in the front and on my right side you can see my nostril much more than my left. I think I have a bit of a retracted nostril, but I still think my columella hangs, especially on the right. From the front, I have a V shape. Can anything be done under local anesthesia or should I go under a full revision? Thank you.

Vartan Mardirossian, MD · Answer

The correction you need may be performed under local anesthesia. Unlike what was written above I do not think that correction of the columella is what is needed, I would rather focus on the right nostril where you are havng an alar retraction. This can be fixed in several ways the most reliable of which involves removal of some skin and cartilage from the ear to correct the notching of the nostril. There are some other, even less invasive methods but an in-person exam is necessary to determine what would be the best method.

Bradford A. Bader, MD · Answer

Your problem seems to be a combination of alar retraction and excess columella. Alar retraction, or notching, is a deformity of the nostril caused by a loss 
of structural integrity. Since the fundamental problem is loss of structure
 and tissue the solution must add structure and tissue. The 
skin-cartilage composite graft satisfies this principle by bringing 
additional skin to lower the nostril margin and cartilage to strengthen 
the nostril and prevent a recurrence of the problem. A skin-cartilage 
graft slightly larger than the amount  of correction needed is harvested
 from the ear and sutured to the under-surface of the nostril. The hanging columella can be corrected by repositioning the medial crura in relation to the septum. This requires more than a simple soft tissue excision under local anesthesia. I cannot comment on your concerns on the frontal view as I do not see frontal view photos posted yet. Overall, I think your concerns are more than can be addressed under local anesthesia and I would recommend sedation or general anesthesia.

Kristina Tansavatdi, MD · Answer

The right hanging columella can be fixed by elevating it under local anesthesia. You also describe some other problems on front view but have not submitted any pictures from the front. A proper examination would be needed to understand the "v shape" and review the width from the front.

Michel Siegel, MD · Answer

Hard question to answer without examination. In general, some options include lowering the right nostril with graft, and that could be a rim graft, or a lateral crural one.Also, the excess columella could be resected without altering the nostrils.Proper combination for you and anesthesia will be better assessed with an exam.Best of luck,

Richard W. Fleming, MD (retired) · Answer

Your columella can be elevated under local anesthesia. If you're considering other changes (you mention a full revision) consider sedation or full anesthesia.

Hanging columella uneven on each side. What can be done? (Photo)

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