Is this a tension nose with hanging columella? (Photo)

Thank you for your question. You are an excellent candidate for rhinoplasty. I think it is one of the most beautifying surgeries that we do as plastic surgeons. In your case, you do have a significant hanging columella and retracted alar rims. A large portion of my practice is dedicated to rhinoplasty surgery. It is important to only see plastic surgeons with extensive experience in rhinoplasty, ie perform at least 6 per month and have performed hundreds of cases. Also, critically evaluate on-line galleries to see if their art form resonates with yours. Rhinoplasty is definitely a grey haired plastic surgeon's sport. You should be able to have an excellent result. Best wishes to you.

There are a few factors that can make the columella hang down like that. The septum can be strong and pushing the columella down. That's the most straightforward issue to correct, and you might have some of it: on your profile line, your upper lip is short vertically before it starts to move forward onto the bottom of your nose, and that's a clue. Then, the columella is part of the same two cartilages that form the tip of the nose, and that attachment can put a limit on the amount of improvement that is possible, because trying to force the columella upward can distort the tip. The task is to balance improvement of the columella with protecting a nice tip. You do seem to have a mild tension tip, which would be corrected with a small take-down of the height of the bridge, so the bridge and tip have a relationship that you like better.

How *much* to change the columella, or lower the bridge, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.