Revision Rhinoplasty: I'm unhappy with my Hanging columa. (photos)

Hello I have had two surgeries so far many years back 1998 and 2001 . Unfortunately i am left with a hanging columa and septum all the way pushed to the right nostril.. Not sure if mine would be an easy fix or not and wondering about approx prices..I showed it to my ent and he said only to go to very experienced dr as my cartilage is weak ...He said leave well enough alone ..Im just very unhappy with this. This would be 3rd surgery. .Would this be a huge surgery and approx how much do u think it would cost? My septum has completely shifted to my right nostril.

Doctor Answers 9

Revision Rhinoplasty - ENT ("Facial Plastic Surgeon") And Advice To Seek Experienced Plastic Surgeon

The good news is that your issues, judging from your photos which are excellent in providing information, appear to be fixable. Your ENT ("Ear, Nose, and Throat Doctor," also called a "Facial Plastic Surgeon") is correct:  you need to seek the help of a very experienced rhinoplasty expert who deals with the outward (as well as inward) aesthetics. I would seek a board certified plastic surgeon with decades of experience operating on the face and nose. With every surgery that is done to your nose, scar tissue develops, and this -- along with your body's natural limitations and whatever the two prior surgeries removed in terms of your nasal structures -- make your surgery complex. But do not feel bad:  complex does not mean impossible. You also appear to have a Polly Tip (also known as a "Polly Beak") deformity, a heaping up of scar tissue on the tip of your nose. Please do not be discouraged, but please seek a true expert in this field. I am sure you have been through a lot. Do your research; look at reviews, photos, and websites, and some surgeons like myself also will conduct preliminary consultations over the phone.

Revision rhinoplasty

You certainly have some issues which will require a revision rhinoplasty. I would not lose hope - they can be addressed and your issues corrected! I consider a rhinoplasty a 4-dimensional operation. The three dimensional framework is determined at the time of surgery by your surgeon, but unless the framework is designed to be strong and rigid, there will inevitably be changes that will occur with the passage of time (the 4th dimension). Scarring and healing will cause contractures and shifting of the tissues in your nose, and if your support structure is weak or inadequate, your nose will change and shift in unpredictable (and usually unfavorable) ways. In your case, I believe that your septum and columella (and other areas of your nose) can be improved and straightened with the use of a rib graft and a structural rhinoplasty. The cartilages in your septum and ears have either already been used or will be inadequate to support your nose, but rib cartilage will be strong enough and abundant enough to provide the structural foundation and support that your nose just doesn't have right now. I would visit a plastic surgeon or facial plastic surgeon who is an expert in revision septorhinoplasties, and discuss the need for a rib graft. If properly done, this will be a wise investment. Best of luck!

Robert Galiano, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 29 reviews

Revision rhinoplasty woes

Hi, Anjalika!  I'm sorry to hear that you are unsatisfied with your result.  I know it must be frustrating to undergo a procedure only to learn that you will need a revision...and then another.  You certainly have reason to question whether a third operation will lead to a fourth.  It's impossible to tell you exactly what you need from these photos, but it does appear from the base views that the septum remains deviated.  It is tough to say whether the columella is "hanging" from the photo you took given the angles, but it doesn't appear from the photo to be  disproportionately low. I think the bigger issue here is the deviated septum. Sometimes what can happen if too much of the nasal tip cartilage is removed, the edges of the nostrils can draw upwards and make it look like too much of the columella or  lower portion of the septum is showing.  

It is difficult to say whether or not this would be a significant or extensive procedure without performing a thorough in-person examination. The cost of a revision procedure can vary greatly depending upon the geographical location of the surgeon and his or her training.  In consideration of a number of factors, you might pay anywhere from $4,000 to upwards of $15,000.   Given the history of two previous nasal operations, you will have more scar tissue in this area, and this always makes the procedure significantly more challenging. Please think carefully about how much this bothers you from both a nasal function standpoint as well as an appearance standpoint. While another procedure may improve the appearance, realistically, there is always the risk of things getting worse. I wish you the very best moving forward and hope that this information has been helpful to you!

The comments provided here are for informational purposes only. They do not imply the formation of a patient physician relationship.

Jeffrey L. Schmidt, MD
Englewood Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Revision Rhinoplasty

You unfortunately still have a deviated septum which you can clearly see in your right nostril. You also appear to have a pollybeak deformity in your profile view. A revision rhinoplasty with septoplasty could most likely be performed to address your concerns but the final internal and external reconstructive plan can only be determined after a physical examination of your nose.   Prices for a revision rhinoplasty vary greatly by location and surgeon expertise.

Gary Motykie, MD
Los Angeles Plastic Surgeon
4.3 out of 5 stars 64 reviews

Revision Rhinoplasty for Hanging Columella

Consult with a revision specialist to discuss your hanging columella, deviated septum, tip collapse, polly beak, and probable breathing obstruction. Then you can make an educated decision about additional surgery and whether or not you want to make any changes. While there are risks with any surgery you should consider your options. Cost will be explained at that time.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 37 reviews

Revision rhinoplasty for twisted nose and hanging columella

This is a very difficult problem to deal with since there are multiple issues with the nose, and this will be your third revision rhinoplasty. To reduce the hanging columella requires shaving down excess cartilage and skin. The columella which is crooked will also need to be straightened. The Polly beak that is present will need to be reduced. Look for a very experienced rhinoplasty surgeon for best results, since this will be a very difficult endeavor. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Correcting a hanging columella

You are correct in that you have a hanging columella and the septum is shifted to the right side further displacing the columella to the opposite side. Furthermore, you may have a poly beak deformity with excess septum remaining along the lower bridge of your nose. Finally, the tip itself appears to be twisted to the right with one cartilage higher than the other side. A revision rhinoplasty would use septum from inside your nose if available to strengthen the columella or you may need cartilage from your ear or rib to support that area. I would recommend a board certified facial plastic surgeon who has experience in revision rhinoplasties. The approximate cost in our area is around 5500 dollars. Good luck in your area.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Deviation of columella

The deviation of columella is partly from soft tissue and partly because of a deviated caudal nasal septum.  Both can be corrected to some degree but scarring prevents an excellent result.  As long as you have realistic expectations you can proceed with surgery with an experienced rhinoplasty surgeon.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Revision nose

anjalika, yes you are a great candidate but only with the right surgeon. You need to search for an experienced surgical specialist that does "only faces" and has great photos. How much improvement you can expect will depend on your exam, the availability of usable cartilage, your skin thickness among other concerns. Review the video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.8 out of 5 stars 44 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.