Is it difficult to lower tip while getting columella surgery?

I have excess columellar show but I'm worried my tip will look too high. Is it possible to slightly lower it while trimming caudal septum? I'm concerned about having a long upper lip.

Doctor Answers 9

Columellar Show

Yes, it is very possible to attain nasal balance, both with the tip and columella relationship and the columella and the upper lip, with a rhinoplasty.   Cartilage manipulation via grafting and removal is the key in obtaining your desired result.  A photo would be quite helpful, but your goals, and concerns, should be very manageable. 

West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Correcting the columella can make the tip *look* lower.

I reviewed your photos, from your previous posts. The photos don't show enough of your face to make the following determination: Often, when the columella is raised, the nose *looks* longer, so it's not necessary to do the very difficult work of actually lowering the position of the tip. With photos that show your profile, from the chin up to the forehead, I could make you a morph and we could see whether that effect would work on you.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Balance in rhinoplasty

It is all about being conservative in keeping balance.  The caudal septum can be addressed to bring the tip down and reducing columellar show without making the upper lip look too long.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 89 reviews

Is it difficult to lower tip while getting columella surgery?

There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

In the operation that needs the bone and cartilage tissues to be involved; open approach is used. In the procedures with open approach, the size, shape and functionality of the nose can be improved. The big nasal bumps can be removed and septal deviations can be corrected providing a better nasal airway.


Excision of caudal septum to improve columellar show can be done in a number of ways to change the rotation and projection of the nasal tip. There are many parameters to take into account for harmony and aesthetics of the face including the length of the nose, length of the upper lip and even height of the person when planning such maneuvers. Thus, the decision is very unique to the person and best done by a surgeon who has a niche in rhinoplasty.

Jacob Sedgh, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Columella-plasty candidate

A columella plasty can address reduction of the hanging columella. Depending upon the angle at which the skin and cartilage is removed from the columella can either raise or lower the nasal tip. For more information and many examples, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Tip deprojection

Hello and thank you for your question. Nasal tip deprojection can accomplish this and fix your columella if good technique is used.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

Nasal tip surgery

Without seeing pictures, its hard to answer your question with much detail. But yes, it is possible to adjust your columellar show and maintain the adequate tip rotation and projection.  It all depends on where you are starting as far as what maneuvers would be performed.  Make sure that you discuss this all in great detail with your surgeon such that they are aware about your concerns. 

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Columella Tip Surgery

Hello,  Some pictures would be helpful to understand your concerns.  We routinely operate on excess columellar show and use a tongue-in-groove technique or a caudal septal shortening technique to lift the columella.  Depending on the amount of rotation you already have, the nose can be adjusted to decrease the rotation if needed.  All of these maneuvers can be performed with CLOSED, Scarless rhinoplasty. 

All the best! 

Deepak Raj Dugar, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.