I would like to get my drooping columella reduced however I have a perforated septum, will this be a problem?

Question

I have a 1.5cm hole in my septum and have had two surgeries to fix it. The first was using cartilage from my ear to cover it but this did not take. In the second surgery a plastic septum button was put in the hole. This worked and has been there for 4 years now. My columella hangs very low so I would like this to be reduced. Will my septal perforation be a problem? I feel like it makes my nose less structurally sufficient - therefore might collapse when messed with.

Steven M. Denenberg, MD · Answer

For example, if your columella is really very low, elevating the columella a large distance can help in the closure of the perforation, depending on exactly where on the septum the perforation is located. Or, if the button is working fine, then your columella possibly can be corrected while just ignoring the perforation. The woman in the short video with this post had her columella elevated a long distance.I usually make computer morphs when I'm answering questions like this, to show the changes that are possible for your nose with surgery, but of course you didn't post any photos. At the *very* bottom of the "Learn more" page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

Philip S. Schoenfeld, MD, FACS · Answer

Your situation is complicated and one that should only be addressed by a skilled rhinoplasty surgeon who is equally familiar with the internal issues of your nose. You didn't mention how you got your septal perforation but I suspect there is little to no septal cartilage available.  A thorough examination of your nose is definitely necessary.  Removing the support of the columella needs to be approached with care.  Stabilizing the lower part of your nose following columella reduction is going to be key but it can certainly be achieved safely.

Samir Undavia, MD · Answer

Yes you can have rhinoplasty to improve your columella with a septal perforation. But you should also think about having the perforation repaired. As someone who does this combination often, there is no better time than to fix both together. In fact repairing the septal perforation can help the columella as an added benefit. It also helps from an insurance perspective because typically the facility costs are far lower as are the anesthesia costs, because a lot of the surgery is covered by insurance.

Eric M. Joseph, MD · Answer

If your perforation is down by the bottom of your septum, near your nostrils, it may have caused loss if nasal tip support with an ensuing hanging columella, and possibly a droopy and underprojected nasal tip. Your candidacy for rhinoplasty would need to be made at a consultation with a rhinoplasty specialist, after an examination and determination of the reason your nasal septum developed a hole. Hope this helps. Dr Joseph

Paul Blair, MD · Answer

Your nose will be a greater challenge secondary to the previous septal surgery and the persistent septal perforation.  The location of the septal peroration will determine how hard or easy to correct the drooping columella.  The narrower the cartilage bridge between the end of your septum and the perforation will determine if a columella strut will be needed.  Then the reason for the failure of your first septal perforation correction comes into play as well as reason for the septal perforation in the first place.  Find a very experienced rhinoplastic surgeon especially one with an ENT training as well.

Fred J. Bressler, MD, FACS · Answer

I am sorry to hear that you have been suffering from a nasal septal perforation. You currently have a septal button, which you apparently tolerate well, but please understand that your perforation has been medically managed with the button, but your septal perforation remains. Do you know what caused your septal perforation? Previous surgery? Injury? Other causes? Understanding this may allow your Facial Plastic Surgery Specialist the opportunity to correct your perforation and hanging columella at the same time. Any support issues can be handled with cartilage grafts if structural support is required. You should have a complete consultation with an experienced, trusted surgeon to best understand your options. Best wishes.

I would like to get my drooping columella reduced however I have a perforated septum, will this be a problem?

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