Columella surgery. Is there any way to fix the columella? (Photo)

Question

I have had 2 rhinoplasty , the first one the surgeon reduced the bridge and the second one ( 2 years ago ) the tip. I really like how it looks from a profile view but I don't like the frontal view. Is there any way to fix the columella ? Also prices for this surgery. Thank you !

Manish H. Shah, MD, FACS · Answer

Hello Christinapdx,Thanks for your question.It is very common to have a post-op hanging columella that can be improved upon with surgery.However, it seems like you have level of alar rim retraction that is making your columella look like it hangs down too much.I would recommend that you consult with a revision rhinoplasty expert in your area to better understand how columellar surgery and alar rim retraction repair is appropriate for you.Good luck,Dr. Shah

Thomas A. Lamperti, MD · Answer

Yes, there are ways of adjusting your columellar position. You also appear to have some alar retraction which is further exposing your nostrils. You can read more about hanging columella repair at my web reference link below.

Juan Carlos Fuentes, MD · Answer

In your case the columella shows more in the front view, because you have an alar retraction, then seems that the columella is too low. Your nasal tip is also over rotated and increases the columella show. You will need the correction of the alar retraction with some alar rim cartilage grafts or composite grafts. You need to have an evaluation in person with a Board Certified Plastic or Facial Plastic Surgeon, to evaluate your case.

Adam Bryce Weinfeld, MD · Answer

You have columella-ala disproportion issues.  This is generally correctable.  There are some other things worth discussing too - the low take off and under-projecting dorsum.  I know that you are several stats away, but you can give us a call if you are interested in traveling.

Tom D. Wang, MD, FACS · Answer

Hi Christina, you do appear to have some columellar excess.  This can be corrected by either raising the columella higher into the nose or by lower the nostrils down on the sides, or sometimes by doing a combination of both.  It's probably best to have an in-person consultation for accurate assessment of the problem and solution tailored to your needs.

Minas Constantinides, MD · Answer

Getting the nostrils and the columella right are among the most challenging things about rhinoplasty. The asymmetry you have between the right and left nostril is particularly challenging. The other surgeons that answered correctly identified the combined problem of a low-set columella and nostril retraction, left greater than right. For such severe retraction often a composite graft, or skin-cartilage graft, from the ear is required to readjust the height of the nostril. This is complicated stuff, so choose a surgeon with lots of revision rhinoplasty experience.

Michael Yerukhim, MD · Answer

Thank you for your question, and I'm sorry to hear that you're still having issues.You certainly have too much tip rotation and too much columellar show. But what's even more severe is the alar retraction. There's also a twist of your tip to the right.The columella can be addressed in a number of ways. The ala retraction can also be repaired - most commonly with composite grafts. And, the right alar base needs to be brought down as well. Everybody has some degree of facial asymmetry, and your right side is slightly smaller than the left. This needs to be taken into account during your surgery, and a subalar graft may be beneficial.Seek a surgeon experienced in revision rhinoplasty for a full evaluation.Best of Luck!

William Portuese, MD · Answer

The photographs demonstrate a hanging columella  with an over rotated tip. A. columella plasty can address reduction of the hanging columella and make that area less prominent. A columellar plasty involves trimming excess skin and cartilage to reduce the amount of show hanging down from the nostril rim. The alar retraction need to be treated with cartilage grafts. For many examples of columella-plasty, and our current price list, please see the link and the video below

Richard Ellenbogen, MD (retired) · Answer

This is an easy fix for me.See my website first the septum caudal is excised conservtively. The he medial crus cartilages and the alar rim are evaluate.Shouldnt be a problem with an experienced surgeom

Richard W. Fleming, MD (retired) · Answer

You have 2 problems which are causing the look that you don't like. Your retracted nostril rims can be lowered with cartilage grafts and the hanging columella can be elevated. These changes will improve both the frontal and profile views.

Columella surgery. Is there any way to fix the columella? (Photo)

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