Do I have a hanging columella? (Photos)

I just wondered thoughts on how to correct my nose tip? I had a past rhinoplasty 8 years ago feel the tip may hang too low. However worried with out that my philtrum will look too long. Also how hard would it be to correct?

Doctor Answers 11

Hanging Columella

A hanging columella can easily be created after an open rhinoplasty if that area of the nose is not addressed. By simply performing an open rhinoplasty, slight rotation of the nasal tip usually occurs. In order to prevent a hanging columella postoperatively, an appropriate resection of the lowest portion of the "caudal septum" should be performed. In addition, placement of "alar rim grafts" can help keep the alar rims in proper position. Correction of a true hanging columella usually involves resecting the correct amount of caudal septum in that area. This can usually be accomplished with excellent results.

New York Plastic Surgeon
4.8 out of 5 stars 21 reviews

Think about it before undergoing revision rhinoplasty

Thank you for the photo.  I agree with Dr. Dugar, don't do anything unless you feel strongly about it. You look pretty good.  That being said I see a combination of hanging columella, retracted ala, and maybe a need for some tip cartilage grafting.

For your type of revision I would see a specialist in revision rhinoplasty and set appropriate expectations.  Umang Metha, MD and Donald Yoo, MD are two of my favorites.  Dean Toriumi, MD in Chicago is mastered as well.

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 76 reviews

You look great - don't do a thing


I do rhinoplasty exclusively for my career and i would say don't do a thing unless your nose bothers you that much that you can't ignore it.  Your nose overall looks good and you look great with it.  I think any additional surgery brings on more risks with potentially less benefit.  Do consult with a plastic surgeon who specializes in revision rhinoplasty to learn all the options but tread carefully. 

All the best!

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 14 reviews

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In your photos, it seems that you have a combination of a hanging columella, over rotated tip and retracted ala, that makes it more noticeable. You may benefit from a revision on those 3 areas, because if you just get the revision on the columella, then your upper lip may look longer. Discuss your concerns with a Board Certified Plastic Surgeon or Facial Plastic Surgeon, and check the options and expectations, so you are fully informed.

Juan Carlos Fuentes, MD
Mexico Plastic Surgeon
4.7 out of 5 stars 65 reviews

Revision rhinoplasty for the hanging columella, etc.

yes you do have a hanging columella and this can be corrected easily by an experienced rhinoplasty surgeon. In addition to this your dorsum, the upper part of your nose, has been lowered too much in my opinion and a cartilage-soft tissue graft will give you a more natural looking nose. See a very  experienced revision rhinoplasty specialist who can advise you how to rebalance your nose.  Look at his actual revision rhinoplasty results and do not rely on imaging. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Hanging Columella


It appears you do have a hanging columella, however, correction should just change the angle of take off of the columella from the lip, and not raise the level of take off. Go visit a few surgeons to have your digital photos imaged so you can see how you should look. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Repair of a hanging columella

The photographs demonstrate a hanging columella which can be corrected with a columella-plasty. This involves trimming back excess skin and cartilage the base of the nose on the inside of the septum. For many examples of columella-plasty and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Is This a Hanging Columella?

Yes you do have a hanging columella which can be be lifted under local anesthesia if you prefer. Based on these pictures I don't think your philtrum will look too long and you will eliminate the surgical appearance.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Hanging columella

Hello from Houston! 

The anterior part of your columella does appear to droop.  That bit of cartilage can be rotated or trimmed through a revision rhinoplasty.  The entire columella does not need to move, just the part closest to the tip.  This would not affect your philtrum much.  This surgery is not incredibly difficult, but because it is a subtle change, I would recommend going to a facial plastic surgeon that understands how to create natural changes.  Find someone who can meet your specific needs and with whom you feel comfortable.

Best of luck,

Dr Rodman

Regina Rodman, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Hanging columella? Yeah, you kinda do.

See the "Web reference" link, just below my response. I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands.

I elevated that hanging columella, and I also raised the tip of your nose just a bit more. You can probably see the changes best in the animation.

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 "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

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.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 41 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.