Can my hanging collumella be corrected with a simple procedure under local anesthesia? (photo)

I realize it is difficult to tell from a photo but I'm wondering if it possible for my hanging collumella to be corrected with a simple procedure under local anesthesia. I dislike the way it appears protruded when I smile. I try to avoid general at all costs due to a possible malignant hyperthermia genetic predisposition.

Doctor Answers 6

Hanging columella secondary to long medial crura, excess caudal septum/vestibular tissue

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There are a number of anatomical reasons for the appearance of a hanging columella.  For your particular case, the medial crura appear long and a medial crural overlay will likely be necessary to properly address the excess length.  While this may be performed under local, it is not a "simple" procedure.  A tongue-in-groove maneuver would be used in conjunction to improve the hanging columella, with/without caudal septal resection and resection of vestibular tissue.  

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Botox And Fillers Can Improve The Appearance Of A Hanging Columella

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Botox,  placed properly in the nasal tip,  may be used to treated a hanging columulla--exposure of the columella that may have resulted naturally or more commonly as a consequence of a poor rhinoplasty. Moreover, small amounts of hyaluronic acid filler, such as Belotero Balance, placed along the alae (the wings of the nose) can further camouflage the columella. These techniques should only be performed by experienced injectors with extensive experience in nonsurgically treating these kinds of problems.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Minor rhinoplasty surgery under local

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Most rhinoplasty is done either under general anesthetic or local with sedation. Smaller, limited surgical procedures can be done under local only and these are often "touch up" surgeries after rhinoplasty. Surgery limited to the columella is ideal for local anesthesia in the majority of times. In your particular case however this may not be true. You have a substantial amount of tissue needing to be removed to raise your columella. This likely means the caudal septum, menbranous soft tissue and medial curae cartilage. There are three issues with local anesthesia. First the attention of the surgeon can be diverted to the management of your anesthetic needs during the procedure. This means he can't keep his focus exclusively on the surgery. Second the degree to which the tissues can be retracted is less. This compromises the exposure of the operative site. Finally certain patients are tempermentially unsuitable for local anesthesia.

Hanging Columella and treatments

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Dear bsg8686,

  • Based on your picture, it can be done by removing a small portion of the lower part of the septum
  • I would have to see other views in order to determine if that is all you would need
  • You want to make sure you have a natural looking result
  • IV sedation (not general anesthesia) would be safe in someone like you for comfort
  • When you are ready, please see a rhinoplasty specialist who can address all of your concerns

Best regards,
Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Hanging columella repair

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A columellar-plasty can repair a hanging columella. This can be performed under local or general anesthesia depending upon the patient's preference.  A columellar-platy involves trimming back the caudal septum (which is cartilage) and trimming back skin on the left and right side of the nostrils along the columella. For many examples, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Hanging Collumela

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Yes this can be done under local or local with a little sedation. Sedation will not put you at risk for MH. Sedation would be a better option for your comfort as well as the surgeons.



Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 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.