Can a hanging columella be fixed with a rhinoplasty? (photo)

Question

hello, i had open rhinoplasty a year ago, and for whatever reason the surgeon did not correct my columella. it hangs lower than my nostrils and when i smile it looks even worse. I do not want to go through the painful recovery of open rhinoplasty again so i was wondering if a hanging columella can be fixed with closed rhinoplasty or tip rhinoplasty?

Farhad Rafizadeh, MD · Answer

The photo shows that you have a slight hanging columella. You do not need to have open rhinoplasty to treat a hanging columella. This is a relatively simple operation that can be done under local anesthesia in the office.

Thomas A. Lamperti, MD · Answer

There are a few ways of fixing a hanging columella. As the others have mentioned this can be done using an incision inside the nose to excise excess skin.

	The other method would be to use an open approach to reposition the columellar cartilages. It wouldn't necessarily be as extensive a surgery as your first since the skin wouldn't have to be elevated as far up.

	The best approach depends a lot on what was done during your first surgery and how your tip was stabilized at that time.

	An in person examination and digital morphing would allow your surgeon to determine the best approach.

	You can learn more about hanging columellar repair at my web reference link below.

Michael R. Menachof, MD · Answer

As with many issues related to rhinoplasty, this is a difficult question to answer. Issues with the columella can be due to a variety of causes. As mentioned in one of the other answers, it could be as simple as removing a little bit of skin and/or mucous membrane just inside the nose, which could be done using a local anaesthetic in the office. On the other hand, it has been my experience that in many of these kind of situations, the real issue is that the tip cartilages need to be rotated upwards (pulling the columella with it). Anything less will often not give a satisfactory result. While it is much easier to do this via an open rhinoplasty technique, it can be done closed in certain situations. In either case, since it just involves the tip of the nose, it can usually be done using a local anaesthetic in the office. Bottom line- the worst possible outcome would be to have a small second operation (chosen because it was small and not because it would likely give the desired result) and still be unhappy with the results. My suggestion- get a couple of opinions, determine the best way to get the result you want, and do that, no matter which approach is needed. Good luck.

Jeffrey Zwiren, MD · Answer

It would be great to see your before and after photographs. The treatment for your hanging columella can depend upon how the initial surgery was performed. Your plastic surgeon is in the best position to help you get your desired result. The correction for a hanging columlla depends on whether or not it is due to a small portion of the inferior aspect of the septum or if it is due to redundant vestibular (nasal) skin. It is possible that your surgeon needed to place a graft in this area to add projection to your nasal tip. In any case this is a relatively minor aesthetic problem and can be corrected with a small procedure usually performed under local anesthesia.

Peter E. Johnson, MD · Answer

It is possible to raise the columella by reducing the lining above, but secondary rhinoplasty is not always 'simple'. A complete exam and computer simulation can help you understand how the nose will look with a procedure which raises the columella alone. Hope it works for you.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question and photograph.  The correction of a hanging columella is a fairly minor procedure and should not require complex recovery compared to an open rhinoplasty.

Ashok Govila, FRCS, MCh, MS - Account Suspended · Answer

HI,

	I think I am seeing your images for the second time.First time you floated only one and now 2 images.Yes we can see a small degree of columella show that can be corrected by small surgery under local antithetic.Stick to your doctor to maintain continuity of care and responsibility for the results to be good or not so good.

Gregory Park, MD - Account Suspended · Answer

The amount of columellar show can be reduced by removing a small degree of skin between the columella and nasal septum. This area of skin (membranous septum) can be removed under local anesthesia. It will not be pain free, but it probably will not be as painful as your first surgery.

Thanks for your questions and photos. Best of Luck!

Thanks for your questions and photos. Best of Luck!

Richard W. Fleming, MD (retired) · Answer

Your hanging columella can be lifted with a single incision between the columella and the septum. I recommend that you do this with just local anesthesia. Obviously, I never saw you before your original surgery but I encourage you to do this because it will give you an excellent result.

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