It has been over a year since my rhinoplasty, and I have two problems: the columella hangs too low & my nostrils look very wide, especially when I smile. I want a revision, but I only want to address these two problems, and not mess with the tip. My surgeon did a weir resection, and I was wondering if I would have to have another weir excision to narrow the base a bit more (and how will this affect the scar thats already there?). how will the hanging colulemma be fixed without worse scarring?
Can I Just Narrow my Nostrils in Revision Rhinoplasty?
Doctor Answers 9
Revision Rhinoplasty for Narrowing Nostrils and Fixing Hanging Columella
Without seeing photos of your nose and examining you in person, it is challenging to advise you as to the best course of action. However, I'm happy to offer a few thoughts.
First, on the issue of the width of your nostrils, revising your prior Weir excisions can certainly be performed without worsening the appearance of your scar, though this is an advanced rhinoplasty technique. Other maneuvers, such as a sill excision may be appropriate if there is too much width to your alar base. as opposed to excessive flaring of the nostrils. I suspect that part of your issue may be a lack of tip support as well. If your tip droops when you smile, this can cause the nostrils to flare and appear wider. Try pushing on your tip and see if this replicates the effect of smiling. If this is the case, supporting your tip with a columellar strut and/or septocolumellar suture may address the issue for you without having to redo your Weir excisions.
The second issue (hanging columella) is typically related to the shape of the medial crura of the lower lateral cartilages. Placing a straight piece of cartilage from your septum between these medial crura (a columellar strut) should straighten them out and give you a more favorable profile. Shaving the leading edges of the cartilages or suturing them up to the septum may also work. Lastly I would add that retraction of the nostril rims can accentuate the appearance of a hanging columella as too much of the columella is visible on profile view. This issue can be addressed with placement of rim grafts to lower the nostrils, another common maneuver in revision rhinoplasty.
You should address the issues that bother you with your surgeon, as he or she has the best understanding of your unique anatomy and what was done during your initial surgery.
Best of luck to you,
Nasal base revision
it is very difficult to give you advice without seeing your photos - it is possible however that all you need is additional tip support which could improve both problems you mentioned
Revision rhinoplasty to narrow nostrils and reduce columellar show
Indeed it is acceptable to trim the membranous and cartilaginous septum, this is how columellar show is prevented. A small incision approximately one inch long is made on the inside of the nostrils along the septum and trimming of membrane and cartilage is done to reduce the columellar show and to tuck the columella inwards and upwards. A revision alarplasty can also be performed through the original incision to excise the old scars. These two procedures can be done by themselves or in conjunction with a revision rhinoplasty if needed.
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Caution in "over-doing" nostril narrowing
Revision Wier incisions to further narrow the base is certainly possible. However, be cautious as, the more you narrow the nostril the more obvious the scar and the more "un-natural" the nose may look.
The "hanging" columella is a fairly straight forward repair and can be done without significantly affecting the tip shape.
Good luck and don't overdo it!..."the enemy of good is perfect"
PS. If you don't like the flare mostly when you smile, a little Dysport or Botox into the alaeque nasi muscle (on the side of the ala/nostril) can stop the flare...temporarily.
Narrow Nasal Base and Elevate Columella after Rhinoplasty
The visible incisions secondary to previous weir excisions would be removed if you decided to narrow the nasal base. Your hanging columella can be elevated by excising excess or relaxed tissue and suturing the columella in proper position.
The overhanging columella can be adressed and corrected, the exact surgical procedure is determined after examination to determine the cause.
Repeat weir resecton to narrow the nostrils ia possible but be carefull you are not askig too much. The Width of the nostrils should be in proportion to your face and nose.
Columella and nostrils
Certainly a revision weir excision can be performed and hanging columella treated. Without seeing photos it would be difficult to say exactly what you would need.