How to fix a hanging columella after a Rhinoplasty procedure? (photos)

Question

I had an open rhinoplasty a little over 6 months ago, in which my nose was made thinner (though no bones were broken), my tip was slightly lifted and a cartilage graft was inserted. Now my collumela hangs and it is even more obvious when I smile. My question is what will likely need to be done to correct the problem, and how long the recovery will be (after the original rhinoplasty, I was noticeably swollen for at least 4 months, and slightly swollen (so that I could tell) for about 5 months).

Vincent N. Zubowicz, MD · Answer

Without physical examination I cannot comment specifically. However you mention you had a cartilage graft and if this was placed in the nasal tip you can expect that there will be further changes in appearance. For the time being I would encourage you to be patient.

Thomas J. Walker, MD, FACS · Answer

You appear to mostly have a hanging columella although you might have some minimal alar retraction. This would require a revision rhinoplasty to be corrected with long-lasting results. In general, correcting a hanging columella is "easier" than correcting retracted alae. I suggest you see a revision rhinoplasty expert for further assessment and to discuss the best treatment options for you. Good luck!

Toby Mayer, MD · Answer

The hanging columella can be removed under local anesthesia It is a minor in office procedure. Return to your surgeon and explain your desire to him and if you are not satisfied seek a second opinion from a very experienced revision rhinoplasty surgeon.

Sanaz Harirchian, MD · Answer

Hi 1989word. Thanks for your question. Your case may be a combination of a hanging columella + mild alar retraction (or possibly just mild alar retraction). An examination is needed to properly diagnose and assess the issue. This can be fixed during revision rhinoplasty, however make sure to find a surgeon who is a specialist in rhinoplasty. The recovery will likely be slightly shorter than your previous surgery, however your tip will likely be swollen for months. Good luck Best Dr H

Vasdev Rai, MD · Answer

It is possible to shorten columella with a relatively minor surgical touch up. Your original surgery was six months ago.  I feel that it is now safe to have columella shortening.

Inessa Fishman, MD · Answer

You are right in noting that post-rhinoplasty swelling takes months to resolve.  The classic teaching is that the nose will take up to a year or a year-and-a-half to settle down fully after a rhinoplasty procedure.  The tip of the nose, with its thick skin, likes to hang of to swelling like a sponge; it makes sense that post-surgical swelling resolves at the nasal tip last.  Follow-up with your rhinoplasty surgeon is key; this gives both of you a chance to monitor your healing progress and address your concerns.  Your rhinoplasty surgeon is also intimately familiar with your anatomy and the details of your procedure.To answer your dependent columella question, you may be a candidate for a simple trim of the inferior-most or bottom part of the septal cartilage.  You may have had a columellar strut placed for tip support, and often trimming the bottom part of the septal cartilage allows the tip to come up nicely while accommodating the strut.  Good luck!

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the photo and question and just corrected one yesterday in the course of a rhinoplasty revision and other procedures.  The procedure vaies based on th cause so go on some consults with experts in your areaDr Corbin

Richard W. Fleming, MD (retired) · Answer

Your hanging columella can be lifted with a minor revision procedure. This can be done under local anesthesia. Talk to your surgeon but I suggest you wait another 4-6 months. It sounds like your healing has been slow.

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How to fix a hanging columella after a Rhinoplasty procedure? (photos)

Answers (8)

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