Is the hanging columella normal and what's causing breathing issues? (Photos)

Question

I had a septoplasty March 2021, no breathing issues prior but DR said I had a very slight deviated septum. Since cast off I have been concerned by how much my columella has dropped and the amount of nostril show I have. I also cannot breathe out of my nose properly anymore. It has suggested to be swelling and my surgeon has given me a steroid spray which has not worked. I am seeking advise around whether the hanging columella/ nostrils are normal and what may be causing my breathing issues?

Thomas A. Mustoe, MD, FACS · Answer

The hanging columella unfortunately is a common problem after rhino and due to the contractile forces of healing that overwhelm the tip support.  Strong tip support with a columellar strut or septal extension graft are necessary as part of the revision.  Breathing problems have a variety of causes including residual septal deviation, internal valve and external valve problems and requires an examination.

Jonathan Kulbersh, MD · Answer

Hello and thank you for your question. Unfortunately, a hanging columella is quite common without ample support for the tip. If your original surgeon didn’t use a septal incision graft or a columellar strut, the columella may have descended during the healing process. However, this should not be causing your breathing problems. The cause is far more likely to be a valve issue or leftover deviation from the initial surgery. Either way, you should schedule an in-person consultation with a board-certified facial plastic surgeon who has plenty of experience performing revision rhinoplasty procedures.

Eric M. Joseph, MD · Answer

The appearance of your hanging columella may be due to your nostril margins lifting, rather than your columella dropping. Sometimes alar retraction and worsening nasal breathing may be due to having too much tip cartilage removed at surgery. If this is the case, you may breathe better wearing a Breathe Right strip. Consider consulting with a rhinoplasty specialist to determine the cause of your nasal blockage which would require an examination. If you in fact have external nasal valve collapse, repair with "alar batten grafts" may be considered. Thank you. Dr Joseph

Is the hanging columella normal and what's causing breathing issues? (Photos)

Answers (3)

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