Hanging columella 6 years post primary rhinoplasty--is revision warranted? (Photos attached)

In my professional opinion, you have alar notching/retraction in the setting of a very long septal extension graft that was too long for the nose. You likely need a revision with articulating alar contour grafts and tip work to address the bulk in the columella/infratip lobule area. I would recommend seeking an in person physical exam with an American Board of Plastic Surgery certified surgeon. ideally, this surgeon has extensive rhinoplasty experience as well. An additional bonus is one who has completed an Aesthetic Society accredited aesthetic fellowship.

The nose can always change slowly over time after initial rhinoplasty. The nostrils can pull up a bit and some of the support of the tip can be lost which can account for the issues you see. Revision rhinoplasty would be best to address these things and the columella can be brought up some while bringing the nostrils rims down some. The bulbosity of the tip can be reduced at the same time. Be sure to see a rhinoplasty expert for consultation.

I suspect that you're hanging columella may be due to a persistently long nasal septum, and a prominent anterior nasal spine. Meet you require revision rhinoplasty in order to lift your columella, and possibly to shorten your nasal septum. Please consider meeting with several reputable rhinoplasty specialists so you could see what might be best for you moving forward. Thank you so much for this question. Sincerely, Dr Joseph

Columellar reduction to reduce the nostril show is a great procedure. It can be very effective in pulling back the columella and reducing the hang. Procedure can be done under local anesthesia and the recovery time is a day or two. No nasal cast or taping is needed. A small ellipse of tissue (membranous septum or posterior edge of medial crurae / distal septal cartilage) are removed. The fresh edges are sutured and immediately you can see the change. It is important to differentiate a columellar hang from an alar retraction which can also give more nostril show. The treatment for alar retraction is different and can be more challenging.
Regards
Dr. J

Hello and thank you for your question. Based on your photographs, you are a good candidate for revision rhinoplasty. Nasal tip deprojection will help your overall appearance. Placement of extended alar contour grafts will also help correct the alar retraction and the hanging columella can be addressed as well. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

The photos show a hanging columella and an over-rotated nasal tip. A closed rhinoplasty approach can accomplish improvement with all of the incisions placed on the inside of the nose. No external incisions are needed and no painful packing is required either