Rhinoplasty: Bulbous tip, dorsal hump, hanging columella? (Photos)

I am curious as to what can be done to improve the tip and curve of my nose as well as the straightening of the tip and the added hooked appearance when I smile. I do not want a completely flush/flattened columella, nor do I want a pinched look that would create too deep a line between the tip of the nose and the nostrils. I am also wondering if my nose will end up looking too small in my profile if I have the small hump flattened/curved. Any guidance or input would be greatly appreciated!

Doctor Answers 11


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Dear Maryclaire12, You would be an excellent candidate for a rhinoplasty to address straightening your dorsum, refining your tip, and slightly elevating the columella. I would seek consultation with some experts in the field of rhinoplasty surgery. You can start this by researching surgeons on realself and find surgeons with many reviews. read the surgeons reviews and if many of these reviews pertain to rhinoplasty surgery then likely the surgeon denotes a large portion of his/her practice to this speciality. You can have in house consultations or many surgeons like myself will start with email consultations and then move to facetime and skype for patients who prefer to travel to an expert. You should review the surgeons before and after photographs and find photographs of noses similar to your own to ensure natural looking results. During consultation you can also have imaging performed to show you the proposed changes to your nose and then you can decide if this is your desired result. Once the desired result is determined then the surgeon will discuss in detail the techniques which will be used to attain your desired nose. See the link below for examples and the video above. Best regards, Michael V. Elam, M.D.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Rhinoplasty candidate to remove the dorsal hump, reduce the hanging columella and bulbous tip

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A  closed rhinoplasty approach can address shaving down the dorsal hump, reduction of the bulbous tip, and reducing the hanging columella with all of the incisions placed on the inside of the nose.  To prevent the tip from drooping when smiling requires releasing of the depressor septae ligament.  For  More Information And Many Examples, Please See the Link and the Video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews


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Hello and thank you for your question. Based on your photograph, you may benefit from a tip refining rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Cartilage grafts may also be used to help improve tip refinement. You may also benefit from a cephalic rotation of your tip to turn up your tip slightly and a conservative dorsal hump reduction.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 173 reviews

Here is what you need

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You need correction of your bulbous nasal tip, refinement of hanging columella, and creation of demarcation between your nasal tip and bridge. Right now your bridge just runs into your nasal tip.  Curve of nose is not bad. Accept it.   

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Bulbous Tip, Dorsal Hump Hanging Columella

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A rhinoplasty to straighten your dorsum, increase tip projection, narrow and define your tip, and elevate your hanging columella will all improve nasal proportions going you a balanced feminine nose. On one picture it appears you have some narrowing of the cental portion of your nose which may be causing some nasal obstruction. This can be corrected with spreader grafts. Consult with a rhinoplasty specialist; you need multiple subtle changes which combined will make a significant difference.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews


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Thank you for your question and photos. Your nose has a mild convexity, over-rotated tip, increased columelar show broad wide tip with poor definition. A surgical rhinoplasty can help improve each one of these aspects to give you a more pleasing aesthetic lines and more balance. You're correct in that if you just remove the hump, the nose may look too flat or short. The tip should be refined and defined, and columela shortened without making it more upturned. Get a consult in person for a full assessment. Dr. Sarah Saxon, a facial plastic surgeon in Dallas is excellent. Good luck

Jeffrey Jumaily, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Rhinoplasty: Bulbous tip, dorsal hump, hanging columella

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The appearance of your nose can be improved with an artistically performed rhinoplasty through an open or closed approach. What would be the best option and exact procedure would depend on an examination and discussion about desired outcome. No one ever "needs" a rhinoplasty. It is an elective procedure and only you can determine if your nasal features concern you enough to do something about improving the cosmetic appearance of your nose and whether it would be worthwhile.  

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how to do it based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person. Additional information about the procedure will help you decide if it is a procedure that you want to pursue. 

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews


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A full comprehensive functional and aesthetic septorhinoplasty can address most of these concerns and should be done with pre-op computer imaging with your surgeon in order to get common and realistic goals before surgery

Rhinoplasty candidate, some advices:

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Thank you very much for sharing your concerns with us.

The harmony between facial parts makes us instinctively recognize the beauty... without knowing it, without defining it, just a perception that surprises and captivates us.

In this regard, I suggest perform a Closed Rhinoplasty (without visible scars) to treat the tip, base and nasal bridge.
With this procedure you get a delicate nose, better harmonize with your other facial features.

Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 367 reviews

Rhinoplasty options

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I think the key will be to define what you would like your nose to look like and communicate this to a plastic surgeon whose before and after photos you appreciate.  You do have the option of non-surgical rhinoplasty for augmenting the glabella (root of the nose) as well as the nostril rim (makes the hanging columella less noticeable).  Of course, the width of the nasal tip can only be narrowed through a surgical rhinoplasty.  I suspect you have something called "cephalically oriented lower lateral cartilages".  By repositioning the cartilages lower the nostrils would come down columella would look less hanging, and tip would narrow.

Good luck with your rhinoplasty journey.

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 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.