What are the effects of surgically correcting a retracted columella? (photos)

Question

-Will correcting my retracted columella result in a shorter philtrum with all rhino techniques? -Will my lip get pushed downwards (i.e. less upper teeth show)? I have come across two techniques. One involves dissecting both the depressor septi (tip) and part of the upper lip orbicularis muscle (Sperli, 2011). This leads to a shorter philtrum, which I desire. The other technique, which I know less about, involves the use of a columella strut graft. Will this also result in a shorter philtrum?

Ronald J. Edelson, MD · Answer

The opposite question is usually what we get asked about, that is, correction of a hanging columella.  If you are interested in rhinoplasty to remove to bump on the bridge of your nose, I probably would not alter your columella at all.

Eric M. Joseph, MD · Answer

Based on your profile photo, you appear to have a long nose and a droopy tip. In many cases of rhinoiplasty surgery, tip narrowing and rotation may result in improvement of a retracted columella, and columella-lowering cartilage grafts may be considered. In any of these scenarios, the length of your philtrum may remain unaffected. Thank you.Dr Joseph

Steven Wallach, MD · Answer

I don to think that muscle procedures do much. A columella strut would probably help. As for a gummy smile, that may be due to vertical maxillary excess.  Surgery to reduce the maxilla a bit may help with that. Botox can be used as a non-invaisve temporary way to soften it.

Andrew Kornstein, MD, FACS · Answer

The depressor septi technique you mentioned only has effects during animation, s.a. smiling,and mostly on the tip via the medial crura.A columellar strut can be functional or cosmetic(or both); like all cosmetic procedures it is not a technique with one outcome but a technique with the effects varying according to the surgeon's knowledge and skill.Hope this helps.

Reza Momeni, MD, FACS · Answer

If the depressed columella is the only presenting problem, it is not necessary in my opinion to perform a very extensive operation.  The appearance of the columella in profile can be improved significantly by placement of cartilage graft, either as a uniform piece or as diced cartilage.  As long as the tip support is good, there are no breathing problems, and that the patient does not wish to have any other modifications to the nose, then this simple approach which can be done with local anesthesia in the office setting is usually very successful and holds up long-term.

What are the effects of surgically correcting a retracted columella? (photos)

Answers (5)

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