Closed or open rhinoplasty? How can I fix my columella? (Photo)

Question

50 year old woman who has always wanted rhinoplasty to fix hanging columella, narrow tip a little and fit to my face more attractively. I want a subtle change but to make the nose appear smaller and, in particular, to fix the columella.

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Through either selection, a rhinoplasty procedure can address the hanging columella, narrow the tip, and create a nasal structure that is harmonious with the rest of your facial features. During closed rhinoplasty, an external incision is made at the base of the nose across the columella and, in most cases, is nearly invisible once it heals. Whether electing for open or closed rhinoplasty, please keep in mind that it is one of the most complex of all plastic surgery procedures, requiring experience, skill, and even artistry to achieve an optimal outcome. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon, with expertise in rhinoplasty techniques. They will be able to conduct a thorough physical examination and determine the type of procedure that is right for you.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have hanging columella and your surgeon cannot fix it with close technique. You may need open rhinoplasty for your wishes. It would be more convenient to decide with face-to-face consultation. Best Regards!

Nima Shemirani, MD · Answer

Hi @37Bet37. Thank you for sending your photos. A bulbous tip and hanging columella are very common concerns and can be addressed with a rhinoplasty. I recommend seeing an expert rhinoplasty specialist for in person examination. A rhinoplasty in my opinion is one of the most difficult procedures to perform. In my practice, I utilize piezosurgery. Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. Best of Luck, Dr. Nima!

Oakley Smith, MD, FRCSC · Answer

Hello,
Surgical rhinoplasty can help you improve the shape of your nose. The overall size of your nose can be reduced, the tip can be defined, the columella can be raised up, and the bridge irregularities can be smoothed. It is better to consult with a facial plastic surgeon and discuss what your nose could look after surgery

Suleyman Tas, MD, FEBOPRAS · Answer

Dear 37Bet37,

Thankyou for providing pictures as a reference. In my professional opinion you may benefit from closed atraumatic rhinoplasty which can address your concern in the least invasive way without cutting the tip of the nose. Additionally, your nose can be straightened and the tip can be reduced and defined and if you have any functional issues they can also be addressed at the same time. Moreover, you may also look into facial rejuvenation surgeries alongside rhinoplasty surgery. I am attaching a link for before and after of this procedure if you would like to look deeper into this surgery.

Best Regards,
TAS TEAM

Celal Alioglu, MD · Answer

Hello you need make a straight your septum and solve breathing problems also correct the nostrils but after the surgery your nose will not be straight for 100 %

Eric M. Joseph, MD · Answer

In our experience, a columellar incision improves visibility, and may lead to a more perdictable rhinoplasty result, especially in the  nasal tip. Hope this helps! Dr Joseph

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

Your concerns can be addressed equally well through open and closed interventions. It is more a question of designing with the surgeon of your choice the characteristics of the outcome you wish to pursue and make sure that you are comfortable with the surgical plan.

Your this nasal skin is relatively thin and it allows for a combination of narrowing, de-projection and reduction in the columella curvature. The main risk in thinner skin is related to contour irregularities and they can be addressed relatively well through both open and closed interventions.

Ronald J. Edelson, MD · Answer

Very simple to treat a hanging columella with closed rhinoplasty, if the surgeon knows how. It should not require any cartilage grafts either. Unfortunately  I think many open rhimoplasty procedures  don’t address this in the same way. They make it too complicated

M. Hugh Bailey, MD FACS · Answer

A full evaluation and definitive advice requires in person examination. A "worm's eye" view of the nasal tip would be helpful to judge how square or "boxy" your tip is. Based on the 3 photos, it seems likely that significant slimming of the tip would make the width of the nose above the tip (the dorsum) more noticeable. In that case, a full rhinoplasty would be better. Tip rhinoplasty could fix the hanging columella via either open or closed approach. If there is any asymmetry of the nose, I would favor an open approach to slim the tip. Consultation with a qualified and experienced plastic surgeon is recommended.