Hanging Columella After Rhinoplasty 1.5 Years Ago? (photo)

Hello i had rhinoplasty in michigan by an experienced board certified rhinoplasty specialist. 1 and 1/2 years ago now. im very happy with the hump that was removed however i seem to have a hanging columella which looks worse when i smile. Ive recently seen the physician who performed the surgery and he said there is nothing i can do and it looks fine ....please advise i feel unhappy and ive already spent $7000 should i seek revision, and referalls for detroit michigan

Doctor Answers 7

Correction of Hanging Columella

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I agree with your dissatisfaction. The hanging columella can be corrected with a relatively minor procedure. Although he's not in Detroit, Dr Shan Baker in Livonia is an excellent, experienced surgeon.

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rhinoplasty revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I disagree with the statement that it looks fine. Your posted photos show the root of the nose at pupil instead of upper eyelid crease level, a hanging columella and possibly some nostril rim retraction. Correction would require a graft to the bridge (to raise the root of the nose), trimming of the bottom edge of the septal cartilage (for the hanging columella), and grafting with or without tip cartilage repositioning (for the nostril rim retraction).

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Hanging Columella After Rhinoplasty 1.5 Years Ago?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes you will need secondary rhinoplasty with cartilage grafts to correction the over resection of the dorsa; hump and strut grafts to improvement the columella deformity. Best to you. 

Secondary Tip Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your rhinoplasty result concerns are as much about alar rim retraction as they are about a hanging columella. To get an optimal result you will likely require columellar correction and alar rim grafts as a combined corrective procedure.

Hanging columella

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on your photos it appears that you would be a good candidate for rhinoplasty, such as the example in the link below

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Well-performed Revision Rhinoplasty Surgery may be employed to improve the appearance of your hanging columella.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I read your concerns and reviewed your photos:

Your excessive nostril show appears to be from an exaggerated curvature of the medial crurae of your lower lateral cartilages. You may have a bit of alar retraction as well.

In my experience, improvement may be obtained with revision rhinoplasty. I might use an open approach, and divide your lower lateral cartilages at their angles to allow them to straighten. I might also consider placing a columellar strut to aid in columellar straightening and to add support to your tip.

You may consider consulting several revision rhinoplasty specialists to see what might be best for you.

Hope this is helpful.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Hanging columella after rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The hanging columella can have several causes after rhinoplasty, and the most common has been over reduction of the upper edge of the tip cartilage, or reduction of the lining in the nose under the ala which causes the ala to rise up and the columella to show excessively. The correction can be straight forward, though often the ala has to be released and lowered, and the columella lifted to keep the tip in balance. We never view secondary rhinoplasty as the easy or quick fix, and suggest more than one opinion to sort things out.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 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.