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

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!

Doctor Answers 15

Droopy tip and hanging columella after rhinoplasty.

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. 

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Droopy tip correction by secondary tip rhinoplasty.

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. 

Fixing a Droopy Nasal Tip afer Primary Rhinoplasty

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.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.8 out of 5 stars 16 reviews

Closed Tip Rhinoplasty for Revision

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.

Yes tip lifting might be easeally corrected with local sedation/si la punta nasal podria ser corregida facilmente

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

Ramon Navarro, MD
Mexico Plastic Surgeon

Revision surgery

It appears that you have some alar retraction as well as hanging columella.  You need to see a Board certified surgeon that does revision rhinoplasty to determine the best and most simply revision.  Donald  R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 36 reviews

Revision rhinoplasty can be simple or complex depending on how much needs to be changed

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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 100 reviews

Droopy nasal tip after Rhinoplasty

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!


Rhinoplasty issue for revision

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 23 reviews

Droopy tip

At 18months it is appropriate to do, what you would need, a pretty simple revision. What you need the most is a strong strut in the columella and possible shortening of the caudal septum. A Facial Plastic Surgeon with plenty of experience in Rhinoplasty and Revision Rhinoplasty should be able to help your situation.

Devinder S. Mangat, MD, FACS
Cincinnati Facial Plastic Surgeon
3.8 out of 5 stars 25 reviews

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