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

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.

Since your nose is part of your airway, we use general anesthetic in nearly all of our patients requesting rhinoplasty. You appear to have an exaggerated curvature of your medial crura, and rhinoplasty techniques may be considered for repair, and achieving less nostril-show. Thank you. Dr Joseph

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.  

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.

Dear bsg8686,Based on your picture, it can be done by removing a small portion of the lower part of the septumI would have to see other views in order to determine if that is all you would needYou want to make sure you have a natural looking resultIV sedation (not general anesthesia) would be safe in someone like you for comfortWhen you are ready, please see a rhinoplasty specialist who can address all of your concernsBest regards,Nima Shemirani