Is There an Easy Revision of Droopy Nose After a Primary Rhinoplasty? Is It Just the Columella? (photo)

Question

I had a rhinoplasty 18 months ago and I am happy with the results but I'm still concerned about the droopy tip which even though improved is still droopy. The tip is hanging a bit even in repose but definitely more when I smile. I don't want to have the muscle cut or altered -- is it complicated to fix it without affecting the muscle underneath? I really don't want to go through a major surgery but if there is an easy fix, I would go for it. Please help me with your professional opinion!

Michael R. Macdonald, MD · Answer

The slight "droopiness" of your nose is referred to as a "hanging columella". In your pictures, this appears to be caused by a slight elongation of the midline cartilage of the nasal septum. A simple fix for this would be to trim 2 mm or so of the elongated septum. This would be a very minor procedure.

	If, in addition to this, it bothers you that the tip of your nose moves when you smile, to resolve this would require a releasing incision of the muscle at the base of the nose (the nasalis muscle) to reduce the muscle's function.

	At any rate, be sure to visit an experienced revision rhinoplasty surgeon (or surgeons) for a face-to-face consultation to fully assess your options before proceeding with any further course of treatment.

Farhad Rafizadeh, MD · Answer

Your profile photo shows that the angle between your columella and your upper lip, the nasolabial angle is less than 90 degrees. it sould be about 100. The procedure is relatively simple and it can be done under local anesthesia. The tip of the nose is lifted superiorly and fixated to the septum after removing some of the lower septum.

Steven J. Pearlman, MD, FACS · Answer

From the posted photos, it seems that altering the tip angle might be achieved without complex surgery. However, it's important to get a personal exam to determine exactly what the cause is and therefore the best course of treatment. It might be as simple as shortening cartilage or resuspending structures. But if the support is missing it may be more involved to get a long lasting result.

Toby Mayer, MD · Answer

Droopy tip and hanging columella after rhinoplasty can be repaired using local anesthesia to correct and reproject your tip. This needs to be done by an experienced rhinoplasty surgeon who knows how to prevent the top from drooping.

Kenneth Hughes, MD · Answer

This can be improved with a closed rhinoplasty with a couple of maneuvers without altering the muscle. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Barry L. Eppley, MD, DMD · Answer

You could have an isolated tip procedure with removal of some caudal septal cartilage and a tip rotation with suture support. This could be done under a closed rhinoplasty tip procedure. This is not a hanging columella or a muscular tip problem.

Ramon Navarro, MD · Answer

yes if only it is the tip it might be easeally corrected trough a light local anesthesia at office instalation of course without any spetial remodelling fillers except your own fat and plastma and besides lifting cartilages  without touching the bones and septum.

	si podria corregirse facilmente mediante anestesia local en la oficina sin tocar el hueso ni el tabique nasal y sin ninguna inyeccion remodelante  excepto tu propia grasa y plasma

Parviz Goshtasby, MD, FACS · Answer

Hello 'casablanca', thanks for your question.  There are several reasons for a droopy nasal tip, including a weak columellar support, bulky/ bulbous tip, over-resection of the nasal septum during rhinoplasty, and a hyperactive depressor septi nasi muscle.  Without more information regarding your preop and current anatomy, or the details of your rhinoplasty surgery, it is difficult to ascertain which of these may be the source.  Based on your photos alone, a columellar strut cartilage graft may help support the tip, giving you a nice result.  Also, your description that the tip droops more on animation (smiling) tells me that you would benefit from division of the depressor muscle.  I am not sure why you have an aversion to division of this muscle, which is commonly performed during rhinoplasty procedures, but it should help your concerns and would be a smaller surgery compared to your initial rhinoplasty.  Good luck!

	-Dr.92660

Steven Wallach, MD · Answer

The lateral view shows a nice profile with the tip angle a bit acute. A slightly more elevated tip may be possible. Best to be seen in person. I do not think that the muscles have to be divided. Good luck.

Aaron Stone, MD · Answer

Being 18 months out you should be able to have a revision if you want one. The limited view photos you posted however are of little help. It is impossible to tell if you have true asymmetry or your head is tilted. I think I may see an oblique deviation of the bridge to the left and on the side view it looks like the nostril rim is elevated more than the columella is hanging. The tip lies 90 degrees to lip so slight upward rotation would be helpful.
	
	The best thing for you to do is see your original surgeon first to see what he/she says. Then take copies of your operative report and photos to a second surgeon for a second opinion. There is no shortage of competent nasal surgeons in New York. Then decide what you want to do.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Is There an Easy Revision of Droopy Nose After a Primary Rhinoplasty? Is It Just the Columella? (photo)

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