Should I Go for a Hanging Columella Revision? (photo)

Question

I had rhinoplasty/septoplasty 10 months ago. Although my breathing is great now, I am concerned with the appearance of my tip. My columella hangs way to much making my nose appear heavy. My doctor said that he can fix it by shaving columella down. I am worried that there's more to it than just an excessive columellar show. Should I go with what he says or should I seek a second opinion? Thank you. Katarina

Raffy Karamanoukian, MD, FACS · Answer

Hanging columellas become obvious from a pronounced columella or from alar retraction.  You may need a combination of corrective procedures to help improve a hanging columella.

Thomas A. Lamperti, MD · Answer

Hanging columella repair in your case may require more than just shaving the columella. You have a quite significant columella show. This may be from a combination of an excessively long caudal septum and/or excessively curved medial crura.

	If you're not comfortable with your surgeon's explanation I'd suggest getting a second opinion from a different rhinoplasty specialist. You should have someone who is well-versed in hanging columella repair do your revision surgery. They should be able to show you before and after photos of other patients who've had similar surgery so you can see their results.

	Check out the link below for more information about treating excessive columellar show.

Eric M. Joseph, MD · Answer

I read your concerns and reviewed your photos:

	Without an exam, it's difficult to say exactly what's causing your hanging columella. It appears to be from an exaggerated curvature of the medial crurae of your lower lateral cartilages as a result of your prior rhinoplasty. Your septum may be too long as well.

	You may require an open approach for correction, so the experience of your surgeon is important. You may wish to consult several reputable revision rhinoplasty surgeons before proceeding.

	All the best to you.

	Dr. Joseph

William Portuese, MD · Answer

A hanging columella is a relatively easy surgical fix to perform called a columelloplasty.  This is usually performed under general anesthesia.  A small portion of both cartilage and mucus membrane are trimmed back to tuck columella in so that the alar columellar relationship is more in proportion. Breathing out of the nose will not change, as the procedure simply removes the excessive columellar show.

Steven Wallach, MD · Answer

You may have a hanging columella, retracted alar or both.  It is always best o be seen in person for exam.  Speak to your surgeon about options.

Should I Go for a Hanging Columella Revision? (photo)

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Should I Go for a Hanging Columella Revision? (photo)

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Answer: Hanging columella?

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