Is It Possible to Lift my Nose Tip Without Surgery?

Question

After two surgeries, the most recent one over a year ago I'm unsatisfied with the bridge between the nostrils as it drops like a hanging columella I was wondering if there was a way to lift it so it won't look so hideous.. Can't smile in pictures because one nostrils bigger than the other and there's skin that shows as it stretches please help

Nelson Lee Novick, MD · Answer

There is no question that  nonsurgical nose jobs not only can work well for curved and bent noses, but also for downturned (or drooping) nasal tips.I have been performing these procedures for well over a decade, and have found nonsurgical nose jobs quite effective for lifting droopy nasal tips (as well as straightening humps, bumps, and depressions along the bridge and top of the nose), all of which often contributes to a slimmer, more tapered nose.

	It is not entirely clear from your description, however, what approach is best for you. An in-the-flesh consultation is certainly advisable.  At that time, if deemed necessary, to confirm whether a nonsurgical approach might be beneficial in this case, a small amount of salt solution or dilute anesthetic solution can be injected as a test into the appropriate areas of the nose to get a better idea of the potential degree of correction.

	Not uncommonly, simply injecting the appropriate volume to the bridge area of the nose to straighten it is also enough to give a secondary aesthetically satisfactory lift to the tip of the nose.

	In cases where sufficient secondary lift is not achieved by simply volumizing and straightening the bridge area, additional volumizing material can be added to the area of the base of the nose, with or without the addition of a neuromodulator, such as Dysport and Botox.. The latter work, not by a volume effect, but by weakening the small muscles in the area that exert a downward pull on the nasal tip: the result, an elevated nasal tip. When necessary, a small volume can be instilled to the lower spine of the nose to further straighten it. Tiny droplets can also be injected along the base of each nares to help to correct an overly exposed columella. 

	Consultation with a board certified aesthetic physician with extensive experience with nonsurgical nose jobs is strongly suggested.

Manish H. Shah, MD, FACS · Answer

Hello Seeking_info,

	From your description it sounds like you develop the appearance of a hanging columella when you activate certain muscles when smiling.  This can be for several reasons.  Firstly, if your surgeon over-resected the lower lateral cartilage to reduce a bulbous tip, you can develop alar retraction and look like you have a hanging columella.  My preferred method for fixing this problem is to derotate the tip by adding extended spreader grafts to push the lower lateral cartilages down to hide an overexposed columella.  This however requires surgery.  If your nasal tip depressor muscles are overactive, your tip will dip when smiling, causing a look that could resemble a hanging columella.  Botox injections to the nasal tip depressor muscles could rotate your tip and columella up a bit hiding the columella a bit.  If you happen to have a true hanging columella, then I agree that a columellaplasty procedure can be performed to raise the columella.  You could also add botox to the muscles responsible for splaying the nostrils with smiling, potentially reducing the skin stretch phenomena you are describing.  However, you may find that when you really need air to move into your nose under aggressive exercise, you may miss the ability to splay your nostrils outward.

	I would say that posting pictures of your concerns from a profile and frontal view would help the surgeons on this site to guide you more effectively.

	Good luck,

	Dr. Shah

Donald B. Yoo, MD, FACS · Answer

Nonsurgical rhinoplasty can add volume and build up the nose, but it can not lift a hanging columella. A surgical technique called a tongue-in-groove maneuver can elevate a hanging columella during rhinoplasty.

Eric M. Joseph, MD · Answer

Non-Surgical Rhinoplasty procedures are typically used to fill an indentation or contour irregularity in your nose. Tip elevation may requires revision rhinoplasty surgery.

	I wish you well.

	Dr. Joseph

Jeffrey Watson, MD · Answer

Unfortunately you can't raise the tip with fillers. Generally, best candidates for a
non-surgical nose job are typically the following types of patients: 1) Those
who want the bridge of their nose raised or who want a hump hidden to achieve a
more feminine profile 2) Patients with a nose that deviates to one side or the
other. Filler can help make it look more straight 3) Patients with features in
the tip that appear too harsh or pointy and need softening. Fillers can help
create a much smoother and balanced appearance. What non-surgical nose jobs
can't do are help patients narrow their nose, make it project (stick out) less,
raise a droopy tip, or help with breathing. For these issues a surgical
rhinoplasty is required.
It is very
important to know that a non-surgical rhinoplasty is a VERY advanced and
technically challenging procedure to do safely. Too much filler in any given
area can cause issues with blood supply to the skin on the nose so it is
essential that you have a physician who is comfortable in rhinoplasty perform
the procedure. There must be an utmost respect for the anatomy and blood supply
of the nose. In experienced hands it can be done safely and beautifully with
results that enhance the appearance of the nose and really help patients feel
more confident. 
Depending on the
filler used, the results typically last between 1 and 2 years. The procedure is
performed after topical numbing creme is applied and should be performed in a
meticulous fashion. This means that the procedure typically takes about 45
minutes.
I hope that helps!
Jeffrey Watson, MDHarvard Trained/Board CertifiedRhinoplasty SpecialistFacial Plastic and Reconstructive Surgeon

Sandy Sule, MD · Answer

lifting the columella when you smile can be done using dermal fillers. The improvement, though, may not be exactly what you are looking for. Filler definitely (I have done this on several patients) can be placed into the columella to give a lift.

William Portuese, MD · Answer

A columellar-plasty can address a columellar show by trimming the caudal septum and skin inside the columella. This surgery can be done under local or general anesthesia. A closed rhinoplasty approach can accomplish making these changes with all incisions placed on the inside of the nose. A Hanging columella gives the appearance of a" bottom heavy" nose. Please see the link and the video below for examples of the hanging columella reduced with closed rhinoplasty.

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