Would a columelloplasty fix this hanging columella? (Photo)

Question

I had Rhinoplasty almost 5 years ago for dorsal hump. Doc told me I would need to refine tip a bit to match changed to the bridge. I now have a problem I never had before. The bridge looks better but now my tip is off. My nostrils are very noticeable from the side, before they were hardly visible. My columella tilts a little more to one side and hangs lower while my tip is upturned. Would Columelloplasty fix this? Would it make my nose look shorter/upturned?

Emmanuel Mallol Cotes, MD · Answer

Thank you very much for sharing your concerns about your Rhinoplasty with us.

After having analyzed all the info and photos provided to us, i recommend to perform a Secondary Rhinoplasty (not a tip revision) this means (basically) treat the nasal bones and the nasal cartilages.Therefore i would perform a narrowing of the nasal base (nose osteotomy) and alar and triangular cartilage shaping.

Respectfully,Dr. Emmanuel Mallol Cotes.-

Marcelo Ghersi, MD · Answer

Hello. It looks like you have two issues going on. Both a hanging columella and retracted alae can be improved significantly with a rhinoplasty.

John Michael Thomassen, MD · Answer

You have a bit of excess columellar show as well as a small amount of retracted ala.  I would recommend treating both by excising some of the columellar projection and using cartilage to correct your alar retraction. Best wishes, Dr. T.

Andrew L. Greensmith, MBChB, FRACS · Answer

You have both nostril retraction ( nostrils have risen up ) and true columella excess - you are correct that just lifting the columella area would make your tip too turned up - you need the tip rotated downwards, the nostril rims lowered and some elevation of the hanging columella - this will not be easy and requires a specialist reversional rhinoplasty surgeon and possibly some additional cartilage grafts if your septum has already been used previously

Bradford A. Bader, MD · Answer

I can see what you are concerned about. You have what we call "excessive columellar show." This can be due to a hanging columella, nostril retraction or a combination of the two. Excessive columellar show in patients who've had a previously rhinoplasty is almost always due to nostril retraction. I suspect that the tip refinement you had during your rhinoplasty included removing some of this cartilage which weakens the nostrils and sides of the nose. The scar forces overwhelm the strength of the remaining cartilage and the result is nostril retraction that develops slowly over many years. This is not an easy problem to fix. You will need an in-person exam and consultation with a very experienced revision rhinoplasty expert to discuss possible solutions. Best of luck!!

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