How can I show more columella without increasing the distance between my nose and upper lip? (Photos)

Question

I’m planning to have rhinoplasty and one of my goals is to slightly increase the visibility of my columella (it's currently tucked in and not visible from the side). However, I already have a slightly long distance between my nose and upper lip, and I’m concerned that showing more columella might make this area appear even longer. Would using a columella strut or cartilage graft to project the tip and columella slightly down and forward risk lengthening the nose-lip distance even more? Is there a technique that enhances columella definition without making the upper lip appear longer? For context, I have a Central Asian background. I'm also considering combining this with tip refinement, bridge narrowing, and augmentation. What surgical techniques would best address my concerns while maintaining natural proportions?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. A columellar onlay graft can be placed for added columellar volume. Based on your photographs, you may also benefit from a tip refining rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. 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

Best wishes and good luck.

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

Jeffrey H. Spiegel, MD · Answer

Yes, we can adjust the columella and lip as a unit to keep things in the right balance. I published  an article about this a few years ago and the safety of doing them together.

Tanveer Janjua, MD · Answer

The columellar surgery always carries the risk of increasing the opening up of the nasolabial angle and making the upper lip look even longer. There is no easy way around it unless you got a liplift. 
One solution can be using a curved cartilage graft from the ear to put in the columella to give it a curve that brings it down without effecting the nasolabial angle. It has to be small graft and curved. 
Regards
Dr. Janjua

Kyle Kimura, MD · Answer

Great question and thank you for providing photos. 
I would agree that your columella is a bit hidden and it can give the appearance of a 'longer' upper lip. I think augmenting the columella will actually improve this appearance. Additionally, you could also benefit from a lip lift procedure that can sometimes be performed at the same time as your rhinoplasty (vs a separate procedure). 
Surgically, I imagine your rhinoplasty would require rib cartilage to project and define the nasal tip and help augment the dorsum. 
I think your best option is to schedule a consultation with a plastic surgeon who specializes in rhinoplasty to really dive deeper into your concerns and perform a thorough evaluation in person. 
Hope this helps and best of luck!Kyle Kimura, MD

How can I show more columella without increasing the distance between my nose and upper lip? (Photos)

Answers (4)