Columella of my nose is not straight. (Photo)

Question

My columella is not straight which made my nose look like turns to right. It happened to my nose in my childhood while playing. Actually i want to know if there is any possible surgery which can make my nose nice and straight?

Jason Roth, MBBS, FRACS · Answer

The most likely cause for the twist of your columella is a caudal septal deviation. The "caudal" septum is a term we use to describe the very end or bottom part of the septum that sites just under the skin of the columella. It usually sits in a little groove on the bone just above your lip. With trauma it can be knocked out of this groove or simply the growth centres can be put of their normal midline growth path so the septum starts to bend to one side. This can be addressed through a septoplasty that may need to include a small incision in the columella to provide the adequate exposure to reconstruct the caudal septum. In my hands this would be a septorhinoplasty procedure. One thing to be aware of is that when the septum is put back in the midline the nostrils and skin will still often remain crooked as they have been like that for so many years. These then need to be carefully addressed individually possibly with rhinoplasty techniques like rim grafts, tip grafts and a columella strut in order to straighten everything out.

Thomas Buonassisi, MD · Answer

Thanks for sending in your photos. This is a fairly common problem. Your nose is off to your Right because your septum is off to your left. It's not possible to completely straighten your nose but it's can be improved significantly. An open Rhinoplasty would allow for repair of the septum and straightening of the external nose together in one operartion. You will need to have reasonable expectations of an improvement and not perfection.Good Luck!

Adam J. Oppenheimer, MD, FACS · Answer

You're a great candidate for an open septorhinoplasty. The septoplasty will correct the bend in the columella, and the rhinoplasty can adjust the tip cartilages. You could benefit from tip reshaping to narrow it and make it more refined.

Toby Mayer, MD · Answer

Septo rhinoplasty for correction of deviated nose etc.can improve your breathing and make a straight and more attractive nose. Your tip can be refined at the same time. See a very experienced rhinoplasty surgeon who does natural noses as based on his before and after photos. Do not rely on imaging.

Sam Naficy, MD, FACS · Answer

Based on your photos it appears that you would be a good candidate for rhinoplasty for your asymmetric columella, such as the example in the link below

Thomas A. Lamperti, MD · Answer

Yes, I can see how your columella is quite deviated to your right. It also appears that your tip itself is also crooked as well. Septo-rhinoplasty surgery can be used to get both aspects straighter if you want. You can read about this type of treatment at my web reference link below.

P. Daniel Ward, MD · Answer

Hi maanhardeep,The crooked columella can certainly be corrected with a rhinoplasty that includes addressing any issues you might have with a deviated septum.Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Based on your photographs, you may benefit from spreader graft placement and a columellar strut graft.  These maneuvers can help correct your deviated septum.  You may also need a septal reset.  The most important aspect is to find a surgeon you are comfortable with.  With good surgical technique, you could have an outstanding result.  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

Tom D. Wang, MD, FACS · Answer

Your crooked columella is likely due to twisting of the lower part of the septum along with possible asymmetry of the nasal tip cartilages.  While it is certainly possible to correct, it may not be perfectly straight even after surgery due to "tissue memory."  This tends to pull the nose back to its original position or shape somewhat.  However, the crooked columella can certainly be improved.  Best of luck to you.

Richard Chaffoo, MD, FACS, FICS · Answer

There are several causes of a crooked columella, the most common of which is a deviated septum. This can be corrected by a very experienced rhinoplasty surgeon. See a surgeon who is certified by the American Board of Plastic Surgery.

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