The skin behind my columella/nasal tip that attaches to my septum appears to have lengthened and is loose - can this be fixed?

Question

The nasal tip is also looser and slightly hooked when smiling. When I wiggle my nose the collumella moves away from the septum with ease and I can visibly see the entire septum. I'm not sure if anything is detached. I'm not sure if this will regenerate without surgery? My nose looks normal when resting. This has happened since using cocaine fairly regularly - I presume the constant nose fiddling and picking, along with chemicals has caused this. Your guidance is very much valued. Thanks

Ronald J. Edelson, MD · Answer

Yiu need to be seen by a nasal surgeon and have the area examined.  Cocaine use can definitely damage the septum but you need a detailed internal nasal exam to figure things out.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your description, you may benefit from lifting your columella.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Robert Kotler, MD, FACS · Answer

Dear Bthomas2016 in Los Angeles, CA:
          When the nasal tip is loose, it may just be that there is a bit too much of what we call the “membranous septum” which is the lining skin of the nose between the columella and the septum.  I think you have made the right analysis when conducting your own self consultation and self examination.  Whether or not this is a consequence of cocaine use is not certain, but in any event you should definitely look into having that situation improved.  Typically, that is not a particularly difficult surgery, but there may be other factors.  So now is the time to help free up your mind, have your consultations, and make a solid decision based on some good homework.  
  
     Do your homework before consultation. Prepare well for your consultation.  When you search, look for rhinoplasty super-specialists. There are other super-specialists for every procedure, e.g. revision breast augmentation, or body sculpting. Impossible for any one MD to be the master of ten or 15 cosmetic procedures. Look for surgeons whose practice is the majority or entirely devoted to rhinoplasty, septoplasty, and associated procedures.  This would include both primary and revision rhinoplasty surgery.  Why not have the most specialized talent in your service?  Consider how much experience the surgeon has doing the procedure you are considering. We all get better at what we do with time and so those surgeons who have a long run of experience are the ones who have learned the most from experience. Residency and fellowship are where the learning begins, but for all of us, time and experience is where the talent and wisdom are amplified. 
  
     Part of your preparation for consultation should be preparing a list of questions beforehand.  Bring a notepad, or I-pad or laptop, with you and take notes as the surgeon answers the question you are asking.  You should spend more time with the surgeon than with the office staff, because you need to get a sense of whether you are comfortable with the doctor.  You should not feel rushed such that you are on a consultation conveyer belt.  If the presentation by the office staff seems a bit to “sales-ie”, that’s also a yellow or red light. Take a friend or relative along since two heads are better than one in gaining information and understanding.  In the end, the purpose of the consultation is for you to be educated, not to be “sold”.  Ask yourself two key questions: “Is this surgeon teaching me or selling?” And secondly, “Can I put my face ― and my life ― into this doctor’s hands? Can I completely trust him/her?”
  
     There are excellent books out there that you can read and use to study up. It is worth the homework time you put in up front so that you make the right decision with respect to choosing a surgeon who has the talent, experience, and degree of super-specialization that you certainly want to have. You want to do it right the first time. 
  
     When you visit doctor’s websites, the most important feature on the site is the before and after gallery.  If there are just a few examples of rhinoplasty or revision rhinoplasty, you wonder how much experience the surgeon has performing such surgeries.  You need to see dozens examples.  The more examples there are, the more likely you will see one or more that demonstrate situations similar to yours.  Look closely at the photos for natural results.  That is what you want.  Nobody wants to carry a sign saying “I have had a rhinoplasty.” You also need to see the computer imaging section of the site. See how closely the actual “after” matches the computer-generated after. Nothing better displays a doctor’s artistic and surgical talent.                                      
  
    Reviews, particularly right here, on RealSelf, are very important and should be carefully digested. The larger the number of reviews, the better.  A consensus is generally correct. 
  
A consultation without computer imaging is, in my opinion, of much less value.  Why shouldn’t you see the predicted result of the procedure the doctor is proposing?  At consultation, photos are taken of you and loaded into a computer system that morphs your present appearance into the anticipated “after” based on your and the nasal surgeon’s input.  Imaging is an incomparable learning tool because it provides a forum for doctor and patient agreement on what would satisfy the patient and what is, based on the doctor’s talent and comfort zone, achievable.  After all, cosmetic surgery is 100% visual.  It is about appearance. So, without a visual evidence of what is planned, how can you make a decision as to whether or not you might be satisfied?  Talking about what your result will look like is worthless and confusing.  To anticipate a successful outcome, there must be a visual meeting of the minds between surgeon and patient. When you shop for clothing, you usually try on the outfit, right. How else can you tell if you would be satisfied?
  
  
  
     Best wishes,
  
 
  
Robert Kotler, MD, FACS 
  
Over 4,500 nasal procedures performed

Kristina Tansavatdi, MD · Answer

The description you have provided of your nose is rather thorough and helpful. However, an in person examination is often needed to come up with a good plan of action. At the very least, you would benefit from having the medial crura (columella) reattached to your septum which would prevent your nasal tip from dropping and hooking when you smile. An examination of the inside of your nose would be necessary given your history of cocaine use. As you probably know, there is a risk for a hole to develop in your nose (in the septum) that can also cause the bridge of your nose to drop from lack of support. We would want to know that before proceeding with any procedure.

The skin behind my columella/nasal tip that attaches to my septum appears to have lengthened and is loose - can this be fixed?

Answers (4)

Answer: Losing tip support

Answer: Losing tip support

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

The skin behind my columella/nasal tip that attaches to my septum appears to have lengthened and is loose - can this be fixed?

Answers (4)

Answer: Losing tip support

Answer: Losing tip support

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.