Hanging columella and nostril show 3 years post-rhinoplasty (photo)

As you've read, hanging columella is an unicorn, never seen unless you are in your 70-80's and due to bad aging.

There can exist columellar exposure due to an inbalance between overly high alar rim that relatively do not cover the columella as required to prevent the "show" of it.

Once this concept is cleard, your nose has a bad over shortening of nasal length, over rotation of the tip and even worse elevation/retraction of alar rims (hence the columellar exposure); it seems you only received resections, removals, reductions, extractions, that's the typical look of a over-resected structure.

It is unacceptable to have a nasolabial angle as high as 50-60º from the horizontal plane, the nostrils visible from the front and that un-addressed alar asymmetry. Very bad work worthing a comprehensive revision. Do research well the reliability and talent of the surgeon, lengthening a nose is one of the most difficult, creative and really amusing tasks for a revision surgeon, all the structures have to be lengthened to derotate tip-columella-nostrils-alae, this entails many grafts to build the missing scaffolding.

Based on your photos, I see three issues: Nostril retraction, a columella off the midline, and a c-shaped nasal appearance. The path of least resistance might be to undergo permanent non-surgical nose job treatments to lower your nostril margins on both sides, and to provide for a permanently straighter nasal appearance. If your columella is truly off the midline, revision rhinoplasty surgery might be necessary to move it back into the midline for a more symmetrical nostril appearance. I hope this is helpful for you to move forward. Sincerely, Dr Joseph

You have asymmetry of your nostrils and also depression of the tip on one side.
You need alarplasty to get more symmetry and a cartilage graft in the depressed area of left tip.
Both can be done under local anesthesia.
Regards
Dr. Janjua

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty. This can be designed to help improve nostril symmetry and correct alar retraction (ability to see inside nostrils). With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon