How to fix a protruding caudal septum? (photo)

Thank you for the photos and your question. When the septum is too long at the base, it can push down on the upper lip. This can change the smile or create a horizontal crease in the upper lip. In most cases, trimming the caudal septum will help. However, depending on where the tip cartilages are attached and any scar tissue that may be present from your first surgery, the repair and reconstruction of the tip may not be totally straightforward. It would be best to see a couple revision rhinoplasty specialists to have an examination and discuss your options. Take care and best of luck!

Hello, thank you for question and provided photos, As revision Rhinolasty can take more time to heal due to previous alterations, and it is needed to know that after completing one year healing process a revision can be performed.Reconstruction of a failed Rhinoplasty requires professionality, when you can benefit from Closed and Atraumatic technique, you will be provided maximal healing, minimal edema&swelling you will be prevented a scar across your columella and tissue damage.Regards,

Hello,Rhinoplasty does not address the function of the muscle that draws the upper lip upward and the tip of the nose downward. The nose will always seem to droop when you smile because this is the function of a muscle. However, the tip can be rotated upward with many different types of maneuvers so that at rest as well as smiling your nose appears shorter. Based on the photos you have provided it is difficult to determine whether trimming the caudal septum will achieve this end. I encourage you to seek a consultation with a board-certified facial plastic surgeon who specializes in rhinoplasty. Best of luck.

Secondary rhinoplasty surgeries can be more challenging due to the scar formation from the previous surgery.  Based upon an exam, one can determine if your caudal septum is deviated and to what degree there is excess.  It is also helpful to know how long it has been since your primary rhinoplasty.  I would recommend being evaluated by a plastic surgeon for a thorough examination.  There are several surgical maneuvers possible to help obtain your desired results.  Dr. Eric J. Wright

I have seen your situation many times. You have what is know as a hanging columella.  This is usually dues to failure to shorten to caudal septum adequately but could also result from the columella strut itself.  You may need the columella strut removed but then you might lose tip projection as well.  Good luck!

Thank you for your question. You are an excellent candidate for rhinoplasty. A caudal septal excision would one of many surgical maneuvers to improve your nose. Make sure to interview surgeons who are very experienced in rhinoplasty. Best wishes to you.

Hello and thank you for your question. Based on your photographs, you may benefit from caudal septal trim to lift your columella and adding supratip definition.  You may also benefit from a tip refining revision rhinoplasty.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system.  You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon.  If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon.

Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon
 

It is not clear whether the columella strut placed at the time of your primary rhinoplasty or an inadequate shortening of the caudal septum is responsible for the appearance of a prominent columella and short upper lip.  This really will need to be determined at a consultation.  You would seep to benefit from some further narrowing of your nasal bones and support of the middle vault with some spreader grafts.  

Thanks for your thoughtful questions regarding excess columellar length, tip support and tip ptosis while smiling resulting in the appearance of a shortened upper lip. A review of your previous operative notes, photos and nasal schematics, along with a complete in-person examination would be necessary to completely answer your questions. That said, it appears that despite a primary rhinoplasty, your septal length, dorsal projection, tip projection and tip support may benefit from a revision rhinoplasty. Often columellar length concerns require resection of the caudal septum, repositioning or re-design of your strut and sometimes lower lateral cartilage enhancements to improve tip position. Your dorsal front view and profile may also require some changes consist with a masculine appearance, but without the excess columellar concerns and droopiness with smiling. Please contact my office if you wish additional information. You may send the documents related to your previous surgery for my review as well. Best Wishes. 

Yes you can have revision rhinoplasty to address your current concerns.  I would suggest seeking consultations with expert surgeons and have imaging performed. I personally like to use digital imaging to help make sure the patient and I are on the same page with their desired results. When performing imaging its important that you take into consideration the patients skin thickness and nasal anatomy so that the morphed or imaged photograph is a realistic proposed result. Once you have done this then review the surgeons before and after photographs to ensure expertise and natural results. See some examples of before and afters in the link below and the video attached.  Best regards, Michael V. Elam, M.D.