Crooked Philtral Column/uneven Upper Lip? (photo)

Question

I've got a bit of a combination problem in that my nose isn't quite "in the middle" and neither is my philtral column. My nose angles one way while my philtral column angles the other way. My question is, what can be done about the philtral column? If possible, I'd consider adding it to my rhinoplasty procedure - I think it would improve my symmetry overall.

David A. F. Ellis, MD · Answer

I cannot tell from the photo if your nose is straight. The tip should line up between your eyebrows and in the center of your chin. To assess this a full face photo including your forehead and chin should taken with the lighting in the center and looking directly ahead. Often it is a deviated nose. Other causes are asymmetrical jaw line and unilateral cheek fullness.

	 

	Dr David Ellis, Facial Plastic Surgeon, Toronto

Parviz Goshtasby, MD, FACS · Answer

Hello 'southrnchic479', thanks for your question. Although I do see the slight curvature of your nose and philtral columns that you are talking about, without more photos from different angles or a full physical exam, it is difficult to ascertain whether you have other instigating factors such as a deviated septum or asymmetric bony/ cartilaginous nasal framework. Depending on the source of your asymmetry, a well-executed rhinoplasty and septoplasty should significantly improve the symmetry to your philtral columns and facial structures. However, it is important to have realistic expectations for your surgery and not seek perfection in order to be happy with your results. Rhinoplasty is a complex procedure that attempts to alter not only the overlying skin and soft tissue cover of the nose, but also the bony and cartilaginous support structures in order to achieve aesthetic enhancement. The complex interplay of these factors make it difficult to fully control the final results. Regardless, please be aware that everyone, including Angelina Jolie and other celebrities/ supermodels, ALL have some degree of asymmetry in their faces and bodies. Thus, try not to obsess too much over your concerns, even if you decide to proceed with surgery. Good luck! -Dr.92660

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