Retracted/hidden columella, caudal septum removed from prior surgery (Photo)

I had a deviated septum corrected when I was 18. I am now 40. The surgeon cut away the lower caudal septum rather than straightening it. Now I have a problem with an odd asymmetrical nostrils and hidden columella. On the side profile my lip profile looks abnormally long. Im looking to have a caudal septal extension graft, based on reading what dean toriumi does. My main question- are most rhino surgeons now are using 3-d computer imaging to simulate the outcome, that's what I would prefer

Doctor Answers 7

Pre-operative imaging of rhinoplasty

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Over the years imaging has gained ground and most surgeon's offices now have some form of imaging. The most advanced is 3D imaging but this remains a minority. Most offices use less advanced imaging like photoshop. Imaging helps patients visualize the possible improvements but also can create unrealistic expectations.

Computer imaging

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Computer imaging does not necessarily translate into a custom made nose. It only gives an idea to the surgeon and the patient to communicate what the desires are. Do not rely on that or you will be sorry. Instead discuss the details of the procedure and what to expect as a realistic outcome with your surgeon.


Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Revison rhinoplasty

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You can use all the computer imaging that you want, but that will not guarantee the result. The "proof in the pudding" is the surgical treatment in the OR.  Best of  luck finding a great surgeon!

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rhinoplasty and imaging

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THank you for your question and photo. Your nose appearance can certainly be improved with caudal septal augmentation such as septal extension. Of course, a full assessment is needed to see what other parts of the nose will be affected. The 3D imaging looks nice but take it with a grain of salt. It is a simulated image based on what the surgeon believe can be done. There is really no guarantee that your result will look like the simulated after photo. Good luck

Jeffrey Jumaily, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

3-d Imaging and Rhinoplasty

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While 3-D imaging may seem enticing, I believe the technology has not been developed enough yet to be truly representative. It is not the 3D image itself that is lacking, but rather the morphing tools that are associated with the imaging programs. This is true across the board, which I why I prefer to use photoshop for imaging, rather than using a proprietary imaging software. I can more reliably represent the specific changes with surgery using a liquify tool than I can with these other programs. Too many aspects of the imaging software are automated to the point that I can't control the morphing with a high level of specificity, in my opinion. Ultimately, the best representation of a potential result is other actual patient results, who have had a similar procedure.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews


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Hello and thank you for your question. Based on your photograph, you may benefit from a caudal septal extension graft and alar batten grafts.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 174 reviews


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You may get a laundry list of opinions here; however, I don't believe that most surgeons use 3D imaging for noses.  They should be able to supply morphed images, but this is something different.

Ethan Philpott, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 20 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.