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

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.

Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 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.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 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!


Parviz Goshtasby, MD, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 2 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 27 reviews

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. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Droopy Nose After a Primary Rhinoplasty?

Many thanks for good pictures. Yes this is possible to lift your tip without cutting the muscles by a procedure called columellar strut that means a cartilage pillar to support your inside your columella to support the tip up which will then pull down normally with the muscles of expression. Wishing you good luck.

Ashok Govila, FRCS, MCh, MS
Dubai Plastic Surgeon
4.7 out of 5 stars 88 reviews

Droopy Tip after Rhinoplasty

You are very fortunate that the "droopy tip" can be corrected relatively easily. The hanging columella can be elevated under local anesthesia to correct what we call excessive columellar show. Cutting the muscle will not improve this problem which you see without facial animation. Cutting the muscle would only help if the tip comes down when smiling.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 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. 

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 47 reviews

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
5.0 out of 5 stars 2 reviews

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 47 reviews

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