Can you fix a hanging columella after primary rhinoplasty? (Photo)

Question

It's been a couple years since my primary rhinoplasty. I feel like my columella is too low and rounded, giving my nose a bulkiness and heaviness toward the bottom, especially when I smile. Is this a simple fix or would it require a secondary rhinoplasty?? My columella feels hard to the touch like my surgeon put cartilage in there. It is also wider than before. Pre-rhinoplasty, my nose had a droopy tip..and now I have a droopy columella!

Walid Sabbagh, FRCS (Plast) · Answer

In addition to the columella hanging there is significant bowing to your columella visible on your side profile This can happen if the tip is de-projected with stitches without shortening the columella cartilages (known as the medial crura). There are options to improve this and I suggest you seek the opinion of your Surgeon as he/she have the exact details of your previous surgery.

Ivan Wayne, MD · Answer

Thank you for your question and I am sorry your rhinoplasty did not go as you had hoped. Looking at our photos I diagnose a combination of a hanging columella (low or rounded) and alar retraction. Alar retraction means the sides of the nostrils are pulled up excessively. An in person visit would definitely help make the best diagnosis but I would suspect you need both the sides of the nostrils lowered and columella raised.This is fairly straight forward for an experienced revision rhinoplasty surgeon and I would advise you to seek one out for a consult.Good luck and I hope this helps.Dr. Wayne

Jag Chana, MD, FRCS(Plast) · Answer

This is a difficult problem since elevating the columella may produce a too upturned appearance and increase the nostril show. Some improvement can be achieved but the degree of nostril rim retraction needs to be addressed. If you pursue this you should seek the opinion of your primary surgeon since he/she will be best placed to understand to what degree a further improvement is possible in the light of what has already been carried out on the nasal tip. If you seek another opinion be sure the second opinion has all the information and op records so that they can accurately advise you.

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_debbie414.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that I'd like to see, based on these photos that you posted.There is a limit to the amount of elevation of the columella that can be achieve, but I elevated some of the columella. But there are other changes that I think could help a lot. For example, you'll see, particularly in the animation, that I brought the tip (and the bridge) of your nose back closer to your face. That change would help make the columella and the entire nose less prominent and less noticeable.Then, I paid particular attention to lowering the bridge of your nose up where it begins, between your eyes.  That area wasn't lowered in your first operation, so your profile line sort of slides from your forehead onto your nose, without the little dip we expect to see in front of the eyes. Again, you'll probably see that best in the animation.Here's a picture of a Roman statue, where there's no dip in front of the eyes. Cut and paste it into a browser tab:
FacialSurgery.com/RealSelf/RomanStatue.jpgYou should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon, and how to tell whether your previous surgeon should be performing your revision. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe.
I'd love to hear what you think of the morph. Did it seem to address your main concerns? I could modify the morph to your taste if you wish.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery.

J. Phillip Garcia, MD, FACS · Answer

Hello,
It's difficult to asses the result without a complete set of before/after photos and a physical examination.  However, a hanging columella and/or alar retraction are correctable problems with revision surgery. I recommend reconsulting with your surgeon to determine whether the cause of this issue was surgical or simple omission during your procedure.
Best of Luck,

Donald B. Yoo, MD, FACS · Answer

Obtaining your previous operative note and consulting with a rhinoplasty specialist would be helpful in determining if your diagnosis is indeed correct. Good luck!

William Numa, MD, FACS · Answer

Thank you for your question and submitting pictures. If your concerns about a low columella and a rounded tip bother you enough to do something about it, then you could be a good candidate for Revision Rhinoplasty surgery. These concerns would require another surgery and undergoing any surgical procedure requires careful attention to detail and consideration for different options. Consider obtaining several opinions before moving forward with any given procedure. Always trust your face to a board-certified facial plastic surgeon or a board-certified plastic surgeon with very extensive rhinoplasty and revision rhinoplasty experience.

Nirmal Nathan, MD · Answer

Your issue can be corrected with a procedure inside the nose. This would not require a full rhinoplasty. Depending on what was done in your primary rhinoplasty, the area could be quite scarred, make sure the surgeon you go to has experience with revision rhinoplasties and is board certified by the American Board of Plastic Surgery or Facial Plastic Surgery. Good luck.

Julian Rowe-Jones, MBBS, FRCS (Eng), FRCS (ORL) · Answer

This needs revision surgery to fix.  You need an experienced surgeon to make sure when the columella is lifted the tip does not turn up too much - you are fine now but more would be too much as you are at the upper limit of normal.  It is important your nostril rims do not come up any further too as this can accentuate a hanging columella.  The best person to speak to first is your primary surgeon.

Bradford A. Bader, MD · Answer

Yes, improving the relationship between your nostrils, tip and columella is possible with revision rhinoplasty. This is tricky and I recommend you consult with a few very experienced revision rhinoplasty specialists.

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