Columelloplasty under local anesthesia? Would this lift or change the shape of my upper lip? (Photos)

Question

I'm quite happy with the bridge and tip of my nose, but ever since a septoplasty over 20 years ago, I've always had a slight hanging columella and felt my nostrils are too visible. I can push the columella to where I think it should be so I think it is only soft tissue. Could the columella be raised under a local anesthetic? Would this lift or change the shape of my upper lip? Also, is it possible this could make my breathing worse again?

Ronald J. Edelson, MD · Answer

It is not clear that the procedure you described is going to work for you.  However, I have done that procedure in others with great success so it is certainly worth looking into further.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, you columella can be lifted under local anesthesia.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   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.  FACS
Harvard-trained plastic surgeon

Johnson C. Lee, MD · Answer

Thank you for your photos. The nostril visibility may either be the columella is hanging or perhaps that your nose is too short and your tip should be elongated. The columella can be lifted under local anesthesia in the office, however it may be uncomfortable with just the numbing portion alone as that is a very sensitive area. It is unlikely that your upper lip will be affected by lifting the columella and your breathing should not be affected as well. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Jeffrey Jumaily, MD · Answer

Thank you for your question and photos. The columella can be lifted in the way that you are doing with the finger under local anesthesia in the office. If you like your nose otherwise then this is a good idea. These photos are limited but the problem is that the tip is too short and upturned quite a bit so you may want to consider addressing that issue, but you don't have to. Consult a rhinoplasty surgeon to discuss these issues.

William Portuese, MD · Answer

Yes, a columella-plasty can be performed under local anesthesia, however it will be very uncomfortable trying to get that portion of your nose numb to undergo the procedure itself.  General anesthesia is usually preferred.

Richard W. Fleming, MD (retired) · Answer

The short answer is yes, I feel very comfortable doing a columellar revision under local anesthesia for most patients. In addition i suggest you ask your revision surgeon about improving tip definition and possibly lengthening your nose. You may choose not to make those changes but you can make an educated decision.

Columelloplasty under local anesthesia? Would this lift or change the shape of my upper lip? (Photos)

Answers (6)

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