Is there a simple way to reduce a hook nose/droopy septum? (Photos)

Question

All I want is to reduce the droopy septum so that when I smile, my nose doesn’t look so turned down. This seems like it would be a simple surgery.

Donald Groves, MD · Answer

Hello and thank you for your question! Unfortunately, no non-surgical options can effectively address a hanging columella (droopy septum). The best solution is rhinoplasty, which can refine your nasal structure while preserving your natural features.

Your hook nose / droopy septum is due to the underlying anatomy- specifically the cartilage. To achieve a more balanced facial profile, a rhinoplasty would selectively refine the tip, pulling up and securing the hanging/drooping columella to a more appropriate position while maintaining harmony with the rest of your nose. This is actually a very common reasons patients seek rhinoplasty.

The specialized maneuvers required to address your specific issues need a high level of expertise and experience, which most surgeons simply do not have. In addition to reshaping your nose aesthetically, your septal cartilage (or an alternative graft material) would be used to create structural grafts, reinforcing key areas like the columella (the strip of tissue between your nostrils). This is crucial to maintaining long-term symmetry and preventing future distortions.

Rhinoplasty is one of the most technically demanding procedures in all of plastic surgery—millimeters make all the difference. If a surgeon is only performing one or two rhinoplasties per month, they simply do not have the level of experience necessary to achieve the best possible result. Your nose defines your entire face—this is NOT a surgery to leave in the hands of just anyone.

I have had extensive training in complex rhinoplasty, working under one of the highest-volume rhinoplasty surgeons in the world (who performs 1,000+ nose surgeries per year). If you’re serious about getting the best possible result, I’d be happy to see you for a consultation (Virtual or In-Person) where we can discuss your goals, perform a detailed examination, and create a customized plan for your ideal nose.

I look forward to helping you achieve the refined, balanced nose you deserve!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Eric M. Joseph, MD · Answer

In general, the repair of a hanging Columella requires a surgical approach. Since this appears to be due to an exaggerated curvature of the medial crura of your lower lateral cartilages, these need to be straightened with rhinoplasty techniques. I am not aware of a simple fix for this. Thank you for your question. Sincerely, Dr Joseph

Steven M. Denenberg, MD · Answer

The low-ish position of your tip is caused by the two cartilages that form the tip -- they would be modified to bring the tip up, and that requires a rhinoplasty. 
How *much* to elevate the tip, and are there other changes that seem to be needed when the tip comes up? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs actually require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Jason Emer, MD · Answer

this is not easy to do non surgically you can add filler and do botox to that are but it will not change the septum. this need sto be fixed surgically but we do BOTH in our office. let us know if you would like a consult. Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear Anna281,
it is hard to tell for sure without an examination. Based on your photos, it looks like you can get the desired shape after rhinoplasty. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

William Portuese, MD · Answer

From the limited pictures, there are several issues going on. The tip cartilages are downwardly pointing and droopy. A cosmetic rhinoplasty can lift the nasal tip for static purposes. When lifting the tip upwards statically, the supratip depression is more prominent and  the dorsal hump becomes more noticeable as well. A full rhinoplasty is going to be required. Rhinoplasty is the most difficult operation to perform in all of cosmetic surgery, so this is not a simple fix. To prevent the tip of the nose from drooping dynamically requires releasing of the depressor septi ligament.

Is there a simple way to reduce a hook nose/droopy septum? (Photos)

Answers (6)

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