Is it hard to fix alar retraction and hanging columella?

Question

I have a retracted alar and and hanging columella from a prior rhinoplasty. I know that revision rhinoplasty is more difficult than a primary rhinoplasty so I am concerned about the ratio risk-benefits, but I really want to fix this. Alar retraction and hanging columella goes worse when smiling. Why this occurs?

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_OliviaAdrianne.html
I made a couple of computer morphs of your nose, and animations of the morphs, to show the changes that might be possible for your nose in truly expert hands.
I elevated that drooping columella, and raised the entire tip, and then I lowered the bridge of your nose. These are difficult, but possible, changes to make in a revision rhinoplasty. In general, the more we want to change the nose, the more likely we are to succeed in a situation like this. The woman in the short video in this post had her hanging columella and long nose improved in a revision rhinoplasty.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your primary surgeon should be performing your revision. You should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morphs. Did they seem to address your main concerns?
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for a beautiful nose, and whether he shares your opinion of what constitutes a beautiful nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

Benjamin C. Marcus, MD · Answer

HiThanks for sharing your photos and concerns. Revision corrections are always a matter of degree. That is to say that improvement can almost always be achieved but absolute correction depends on what the primary surgeon left behind. In your case there is certainly room for improvement. This will likely require composite grafting and possible tongue in groove procedure. Make sure you see a revision specialist. Dr. Pietro Palma in Milan is outstanding

Jay Calvert, MD, FACS · Answer

Hanging columella and alar retraction are very fixable.  However, it is never easy to strike a great balance between the two.  Typically, I use rib cartilage and composite grafts from the ears.  The scar tissue can cause problems even in the best executed secondary rhinoplasty.

Peter Callan, MBBS, FRACS, MBA · Answer

Hi there. Yes this is fixable.  Providing the skin is soft and supple, both are correctable with advanced rhinoplasty techniques. They require cartilage grafts usually from your nasal septum (if available) or from somewhere else (such as rib) if unavailable. I hope this helps.

Michael R. Menachof, MD · Answer

While it is true that revision rhinoplasty is more difficult than a primary rhinoplasty, if all you're looking for is to correct the hanging columella and alar retraction, these are things that should be able to be improved relatively reliably with a revision surgery.  Look for a well respected rhinoplasty surgeon experienced in revision rhinoplasty in your area and schedule a consultation.  The reason that the alar retraction and hanging columella gets worse when smiling is that when you smile, the facial muscles pull the ala up and pushes the tip of the nose downwards, making it even more noticeable. Good luck.

Pravin Reddy, MD · Answer

Thank you for the question.
In very general terms, alar retractions may be corrected with Batten grafts to "reinforce" the alar rim.  They sometimes can occur with over resection of the alar rim at the time of the original rhinoplasty.  The grafts are commonly harvested from ear cartilage, favored by some because of it's natural curvature, or septal cartilage.
The hanging columella is correctable by a membranous resection which is not a difficult technique.
The above are general answers to your question.  The specific answer to your question may only be determined with a review of the operative notes of the original surgery and personal consultation with a Plastic/Facial Plastic Surgeon.
I hope this answer provides some general guidance and wish you luck in finding the proper solution.

Is it hard to fix alar retraction and hanging columella?

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