Nose too big and excess nostril show, plus asymmetry - Options? (photos)

Question

I had a rhinoplasty before but I’m not really satisfied with the results: The tip of my nose looks way too big and I have excess nostril show. Also, there’s a genetic difference between my two profiles, on the left side my columella show is 6-7 mm, while on the right it’s 8-9 mm! I read it should normally be about 2-4 mm. I attached some photos. Do I also have alar retraction? Can these be fixed somehow, if yes, how? Can I ever have a symmetrical nose? Thank you.

Randal Haworth, MD, FACS · Answer

Hello !

Based on the pictures you provided, it looks like you have a condition called “hanging columella” that allows too much nostril show. It can unfortunately result from the past rhinoplasty.

To correct a hanging columella, one possible method involves shortening an excessively long nasal septum by trimming its end. The two cartilages located in the nasal tip that rest within the columella can be repositioned upwards and secured to the septum, resulting in a stable nasal tip structure. Additionally, some of the skin in the columella area may be removed and reattached upwards.

I would advise to opt for a board certified plastic surgeon expert in revision rhinoplasty for the best results.

I hope this helps,
Best of luck !

Randal Haworth

Eric M. Joseph, MD · Answer

Based on your photos, that does not appear to be a significant difference in your nasal appearance after rhinoplasty. Depending upon your examination, revision rhinoplasty may be considered for achieving narrowing of the lower 1/3 of your nose and repair of your hanging columella on both sides for a more symmetrical nostril appearance. Hope this helps! Dr Joseph

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Assuming it’s been a year or more since your initial surgery, you may benefit from a revision to correct your nose’s appearance. During this procedure, the nose can be resized and reshaped, and cartilage can be excised to reduce the columella and nostril show while improving symmetry. 
Please keep in mind that each subsequent nose surgery becomes more complex due to the loss of structural support, scar tissue, and other factors. The importance of experience, expertise, and artistry cannot be overstated. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to review your surgical history, discuss your concerns with you, and help you decide on the best course of action.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.I have evaluated your case regarding the information you provided and your photos.From the photos it looks like your columella is very down, it needs to be lifted (same for your tip). There is an asymmetry between both nostrils (that is mostly because of the columella). I recommend you a revision surgery, but please keep in mind that 100% symmetry is never achievable.

William Portuese, MD · Answer

You do have a hanging columella which can be reduced by excision of extra skin and cartilage on the inside of the nose. It's very important have realistic expectations moving forward with a revision rhinoplasty, since there is no perfect nose And your nostrils will never be symmetrical. Just like there is facial asymmetry, There's also nasal asymmetry which is genetic.

Nose too big and excess nostril show, plus asymmetry - Options? (photos)

Answers (5)

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