What is the best way to improve a retracted columella? This would be a revision surgery. (photos)

Addressing your tip projection and tip work doesn't really change the columellar retraction, but this can certainly be addressed at the same time during revision rhinoplasty surgery.There's no one proper treatment for the columellar retraction. In isolation a plumping graft in which tissue is place under the skin in the area can help. In other instances different types of cartilage grafts can also be used.

As you point out in your post, the tip is still very projecting, and the nose is long, with the tip hanging down. Those are common results after rhinoplasty, because de-projecting the nose and elevating the tip require advanced work on the tip cartilages, places where many surgeons fall short.The good news is that 1) elevating and de-projecting the tip are two of the most predictable changes to make in a nose in expert hands, even in a revision, and 2) elevating the nose in particular helps expose the columella.See the "Web reference" link, just below my response: I made a computer morph, and an animation of the morph, to show what your nose might look like with the tip de-projected and elevated. If you watch the animation carefully, you'll also see that I reduced the strength of your nose up where it starts, just below your eyebrows. It's important to reduce that area if we want the nose to look less prominent.I don't see anything here that would require grafting.You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle. Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Judging from the photos, it appears that your nose is slightly prominent both with respect to the dorsum as well as the tip.  Also, the tip droops or is under-rotated,  which gives the illusion that your columella is retracted.  Finally, the base of the columella, as well as the tip, is deviated slightly to the right side indicating a minor dislocation of the base of your septum.The good news is that repositioning the caudal septum combined with de-projection and slight rotation of the tip will significantly improve the appearance of your nose.  The dorsum will likely require a minor reduction as well to allow better aesthetic balance between the bridge and tip.  It should be noted that these changes require advanced techniques that should only be trusted to an experienced  facial plastic surgeon who performs revision rhinoplasty on a frequent basis. 

Dear Ksee,Sorry to hear about your concerns.  While it is impossible to tell with certainty from photos, a retracted columella does appear to be present.  The over projection is another issue.  These can all be addressed with a revision surgery, but would require an in-person examination to tell you more about methods, etc.  See an experienced revision surgeon and bring your old photos and operative notes.I hope this helps you!Best,Dr. Most

Hi, I have performed and taught Rhinoplasty for over 30 years.  From the photos, your nasal tip is over projected and under rotated.  The under rotated nasal tip is responsible for hiding the columella that should have from 3 to 5 mm's of show on a profile view.  The tip is also a bit wide.  In this scenario, an Open Revision Tip-plasty would be able to thin the tip, decrease the projection and create the appropriate amount of upward tip rotation.Hope this helps. 

Dear Ksee, The main issues that you have with your current result are the over projection of the tip and the length of your nose. When these are corrected the columella will be more visible. I would suggest seeking consultation with some experts in the filed of rhinoplasty and reviewing before and after photographs of similar noses. I would also highly recommend that you have digital imaging performed to see the proposed changes and how these will effect your over all aesthetics. I do not see any need for grafts in your revision procedure and in the hands of a skilled surgeon you should have a very favorable result. Best regards, Michael V. Elam, M.D.

With these pictures it appears that your problem may be secondary to a slightly hanging tip, some retraction of the columella  posteriorly at the lip, and an over-projected tip. This can be improved with revision surgery, but an examination is necessary to describe specific techniques.