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

Question

Hello! I have debated whether to inquire about this, but decided it was time. I had a primary rhinoplasty 6 years ago. The 2nd image (right lateral profile) is about 6 months after the surgery, at a point where I was quite pleased with the result. Since then, I have noticed some significant changes that I am concerned (and honestly dejected) about; they include increased nostril show (I measured about 5-6mm), a hanging columella, and resulting bulbous tip (especially apparent at a 3/4 view). I was hoping that a professional could provide some clarity regarding these concerns (e.g. whether they are valid, if I should make peace with this result, or could benefit from a revision in the future). I was hoping to never have surgery again, yet I find myself at a crossroads. Being that I am not a facial plastic surgeon, I cannot pinpoint what caused the slight deformity, and I would greatly appreciate any feedback from a technical aesthetics viewpoint. Any input at all would be incredibly helpful. Thank you so much.

Gianfranco Frojo, MD · Answer

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.

Andrew Miller, MD · Answer

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.

Eric M. Joseph, MD · Answer

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

Tanveer Janjua, MD · Answer

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

Richard G. Reish, MD, FACS · Answer

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

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

Answers (6)

Answer: Columellar reduction

Answer: Columellar reduction

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

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Everything you need to know about Revision Rhinoplasty

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

Answers (6)

Answer: Columellar reduction

Answer: Columellar reduction

Answer: Revision rhinoplasty

Answer: Revision rhinoplasty

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.