How To Address Hanging Ala and Create Harmony With Columella? (photo)

Question

I have overhanging ala on both sides of my nose, although it's much more prominent on one side (see pics). Part of the reason why one profile looks different than the other is that my nasal bones and septum are actually canted. But that's another issue altogether. What I'm looking for information on right now is how the hanging ala would be addressed. I want to create that nice relationship between the alar margin and columella. Thanks.

Aaron Stone, MD · Answer

It sounds like you think the outer nostril rim near the lip lies to low. Your posted photos do not support that premise. They show notching of the nostril rims (left more than right) where the alar groove meets the nostril rim. That notching can be corrected by swinging the tip cartilages downward and/or placing a cartilage graft just below the tip cartilages to push the notches outward.
	
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Steven Wallach, MD · Answer

Each side of the nose is a bit different.  An exam in person would be beneficial to determine what would be best for you.

Richard W. Fleming, MD (retired) · Answer

The problem is primarily retraction of the nostril rim which can be corrected with small cartilage grafts under the skin at the nostril margin. The alar-facial junction can be repositioned, but I don't think that will be necessary.

How To Address Hanging Ala and Create Harmony With Columella? (photo)

Answers (3)