Can my loose columellar skin be fixed? (photo)

hello thank you for your question and provided information as well. based in your question and the picture you showed What you explained is not an unusual problem. Both caudal cartilage and skin is removed and stitched. Artistry lies in precision of angles at which caudal septum is modified. That is what determines the outcome from this endeavor.in your case i can do rhinoplasty with technique open and elevate the tip .

Thanks for the question.  This us actually  a simple fix which I’ve done several times.  I would remove about a 4 millimeter strip if cartilage from the caudal septum as well as excess lining from the inside of the nose.  This will relieve the tethering if your upper lip as well.  Simple operation with easy recovery.

Hi Troy,Excellent question.  Fortunately in rhinoplasty when the nose is reduced, the skin always contracts down to "fit."  In your case, your nasal spine at the base of your nose as well as some of your caudal nasal septal cartilage can be removed to decrease the obtuse lip-nose angle to a more masculine angle of about 90 degrees.   As with any aesthetic treatment it is essential to choose your treating physician carefully based on their experience, skill, knowledge, care, and most importantly their natural artistic vision.  A few excellent rhinoplasty surgeons I would recommend are Sam Lam, MD (Plano, TX), Rod Rohrich, MD (Dallas), and Ari Hyman, MD (Encino, CA). Good luck and be well.
Dr. P

Hello and thank you for your question.  Based on your
photograph, you may benefit from a caudal septal trim and lifting the soft tissue to elevate your columella.  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

The fullness at the base of the septum is part of a set of physical characteristics referred to as a "tension nasal deformity." The correction is fairly straightforward and involves removal of excess cartilage and bone that causes the skin to be tight in that area. Sometimes removal of the redundant nasal lining is required to recontour the skin (if it is made loose) after removal of cartilage and bone. You seem to have a very good understanding of the problem and should be pleased with the result of the correction. Good luck to you. 

What you have described is not an unusual problem. Both caudal cartilage and skin is removed and stitched. Artistry lies in precision of angles at which caudal septum is modified. That is what determines the outcome from this endeavor.

 The photograph demonstrates a prominent nasal spine and excess caudal septal cartilage in addition to excess skin. A columella-plasty can accomplish improvement of this area to give less obtuse angle.

The skin of the columella is tightly adherent to the underlying medial crural cartilage. When the columella contour is corrected by reducing the cartilage/bone at the nasolabial angle the medial crura will be sutured to a new, higher position and will carry the skin along. Skin excision in this area is needed sometimes and the incision is hidden inside the nose. This should be a fairly straightforward case for an experienced rhinoplasty surgeon. Good luck!

The sub-columellar skin can be removed through an internal nasal incision at the same time as the excess caudal septal skin is removed. When you discuss this with your surgeon, you need to specifically tell them what you want the end results that you are seeking look like. One way of doing that is to take a blown up picture of the profile picture that you submitted and draw on it to show exactly how much columellar show you would like.  It should be a relatively easy result to achieve, if the surgeon knows what you want..

Yes, addressing the caudal septal excess and columella will address what we call a tension tip, where the tip of the nose is tented distally.  The skin will not stay loose and will contract to the new structure after rhinoplasty.  These elements can be performed to maintain a natural, and subtle improvement in this area.  Good luck,Kailash Narasimhan, MDBoard Certified Plastic Surgeon, ENTnpstampabay.comRhinoplasty Specialist