What could improve my flat columella? (Photo)

Question

Hello, I have a very high placed nose with a flat columella. I know fillers don't work for a flat columella, but I have had a septum piercing before and I was wondering if I gauged it, that it might round out my columella. My first thought was fillers, but I've read that this doesn't work well. I wish I could post a picture but it's not giving me the option. Thanks

Eric M. Joseph, MD · Answer

Based on your single profile photo, you appear to have an overprojected nasal appearance in the lower 1/3 of your nose, which means that it sticks out a bit too far. I agree that this is associated with an upward curvature of your columella. If you are just looking to make your columella appear straight on profile, depending on your examination, microdroplet Silikon-1000 nasal injections maybe considered for adding a little bit of volume into the area that you would like lowered. I do not believe that gauging your nasal piercing would be of significant benefit. I hope this helps! Sincerely, Dr Joseph

Ramin Behmand, MD, FACS · Answer

You’re absolutely right—fillers aren’t a good solution for a flat columella, and avoiding them is wise if you’re considering surgery in the future. Fillers can create scar tissue that makes surgical correction more complex.

Based on your profile photo, there are a few key factors contributing to your concern:

1. A flat, under-defined columella

2. A short nasal length, which creates a wide angle between your upper lip and columella

3. Slight overprojection of the nasal tip

These could be improved through:

1. Moderate nasal lengthening with spreader grafts

2. Lowering the tip

3. Adding a columella graft

Additionally, your profile balance may benefit from addressing chin underprojection, which would enhance overall balance.

— Dr. B.

Gary M. Horndeski, MD · Answer

Unfortunately, you have only provided a lateral photograph.  However, the distance between your nose and upper lip is too great.  You may benefit from a lip lift.  A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.  This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Tanveer Janjua, MD · Answer

The nose ring could have caused scarring and the scar could have pulled the columella inwards. The best option would be a cartilaginous graft to push out the columella. It can be from pushing your nasal septum outwards or using ear cartilage to give it a curve. 
Regards
Dr. Janjua

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers.   A columellar onlay graft could be added to help your columellar flatness.  With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

What could improve my flat columella? (Photo)

Answers (6)

Answer: Flat retracted columella

Answer: Flat retracted columella

Answer: Rhinoplasty

Answer: Rhinoplasty

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What could improve my flat columella? (Photo)

Answers (6)

Answer: Flat retracted columella

Answer: Flat retracted columella

Answer: Rhinoplasty

Answer: Rhinoplasty

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Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.