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

Hello and thank you for your question and the pictures. You actually have a difficult problem. To properly address your nose and improve your facial balance, you would need a rhinoplasty with nasal tip deprojection to improve the overall harmony of your different facial features. This would also allow for adjustment of the columella so there is less nostril show- and it would allow for precise refinement of the tip.

This truly a surgery of millimeters- and tip deprojection is one of the most technically challenging surgical techniques! For those reasons (any many others), I would ONLY recommend being fully asleep for this surgery- anyone who tells you otherwise is doing you a huge disservice! Because your nose is the DEFINING feature of your face- I would only recommend seeing a surgeon who specializes in rhinoplasty procedures, and who has significant training and experience performing these surgeries. I actually trained under one of the world leading rhinoplasty experts (who performs 1,000+ nosejobs annually).

I recommend for you to setup a formal consultation with me (or another plastic surgeon who is extremely comfortable with rhinoplasties) to thoroughly discuss your surgical goals, undergo a formal examination, evaluate your options, and develop a personalized plan just for you. I hope this helps!

Dr. Donald Groves
Aesthetic Plastic Surgeon

Based on your photographs, I think that you have excessive nostril show because your nasal septum may be a bit too long. That appears to be pushing your columella downwards, and this is also associated with a prominent anterior nasal spine. That is the piece of bone that causes a tension nose, often called a tension lip deformity. Rhinoplasty techniques are often utilized to improve these two specific issues that are bothering you. In that regard, please consult with several reputable rhinoplasty specialist so you could see what to expect after surgery. I hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

Hi from Istanbul. Yes, your nose does exhibit characteristics of a tension nose with a hanging columella. This can be corrected through a procedure that adjusts the orientation of your nasal cartilage in a three-dimensional manner. A closed rhinoplasty approach can be used for this type of correction, meaning there will be no visible scarring. Hope this helps, best of luck!

I recommend an open rhinoplasty to change the position of the columella. Your medial crura needs to be elevated higher and the columella needs to be shortened.

Best Wishes,

Gary Horndeski, M.D.

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.

You do have a hanging columella more so than a tension nose. The hanging columella is simple to correct as part of an overall rhinoplasty. Even so many surgeons fail to correct this. I know this because I see many revisions where there is a hanging columella. Make sure you address this at the time of consultation

Hello. Yes, the appearance of your nostril less and the correction of your nose tip is achieved by the rhinoplasty process. Even with preoperative smilation and photoshoping work, your postoperative nose shape can also be designed. However, this surgery is performed under general anesthesia.

You have a dorsal hump, a tension, nose, and hanging columella. A closed rhinoplasty approach can accomplish improving all of these issues. No external incisions are required and no painful packing is required either. This procedure is performed under a one hour general anesthesia, monitored by a board-certified physician anesthesiologist. Choose your rhinoplasty specialist very wisely based on extensive experience reducing the hanging columella with a closed approach. Study your perspective surgeon's before and after rhinoplasty photo gallery.