I have flaring nostrils and a hanging columella. What would it cost/how difficult would it be to correct this? (photos)

Question

Wanted to see what would get this corrected. I'd like to have a nose that shows less flaring on the sides. How much would this cost and how difficult would the procedure be? Would the look of my nose be improved with Rhinoplasty or would a non surgical nose job work better? Is it possible to get my hose to look like the pic that I included which would be ideal looking?

Alejandro Nogueira, MD · Answer

To begin with, hanging columella DOES NOT exist (except for very 
elder and heavy noses), it is incorrect to attribute the "ptosis" or 
droopiness to what should be called columellar exposure / show, excess 
of visibility, septal mucosa exposure / show, but never like "hanging", 
since it is not an ongoing or progressive process, it is just an 
anatomcal feature of stable situation.

Columellar excess of visibility can be cause by different factors, of
 greater or lesser contribution on each of such cases, like: alar rim 
retraction or vertical shorfall, oversized thickness of medial cruras, 
prominent caudal septum, oversized too long lateral cruras, sebaceous 
skin, etc; on each case the treatment has to be customized to address 
the specific underlying causes to the columellar exposure.
Yours seem to have as main cause the overly short vertical length of 
the alae, aka alar rim retraction but better said shortness of alar rims
 in vertical fashion, leading to exposure of the septal mucosa and the 
columella. As secondary factor I detect an slight oversizing of the 
infratip lobule.
The treatment I recommend in your case is, mainly, lateral crura 
caudal extension batten grafts to lower the alar rims and thus supply 
the missing "curtain" to cover the septum and the columella; additionaly
 you need to sink in very very slightly the columella by means of a very
 cautiously practiced tonghe-in-groove securization of the medial cruras
 to the caudal septum. 
Under NO circumstances you should admit trimming the caudal septum, 
that is the "easy way" for surgeons with poor understanding / skills 
about exposed collumellas and retracted nostrils; by doing a caudal 
septum trim you'd get a grotesque piggy nose.
Composite graftings are not very reliable, I don't like them at all, 
they are also "easy" but unpredictable, you can't test them, you can't 
fix them with suture, etc; it is way better (and also more complex) 
direct visualization, intraop unlimited and versatile testing of the 
lower push required and finally fixing and securing in place the grafts 
with sutures.

Regarding your wish pic I can tell you is is feasible, by means of advanced techniques of tip plasty, eventually Sheen's graft.Difficulty 8 out of 10 in primary rhinoplasties, surgical time 3-4 hours.
If you wish better grounded opinion please do post or send privately 
well lit, focused and standard images: frontal, both lateral and both 
oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

John Michael Thomassen, MD · Answer

You have more of a retracted ala than a hanging columella.  A cartilage graft can be used to fix this.  In addition your tip is bulbous and slightly inferiorly rotated.  This can be fixed with sutures and reduction of cartilage.

Scott Trimas, MD · Answer

You appear to be relatively spot on for your analysis of your nose. You also appear to have a bit of a wide bulbous tip and I suspect that the cartilages that are forming it are overly rotated which is forcing your tip down and your ala to appear retracted resulting in the flaring that you describe. A rhinoplasty procedure with redirection of your ala to a more normal position with a technique that will raise your tip should help to correct your problem and give you the desired result. The approximate costs of the procedure in our area is about 5500 dollars. Good luck in your area.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from alar rim grafts to help with your nostril flare.  You may also benefit from a cephalic rotation of your tip to turn
up your tip slightly.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

The hanging columella can be addressed with a columella-plasty which can also lift the tip cartilages upwards as well. The  alar retraction must be treated with a composite graft of skin and cartilage harvested from the ear. Rhinoplasty is the most difficult procedure to perform correctly in the entire field of cosmetic surgery, so it is important to choose your surgeon based on extensive experience. For more information and many examples of both composite grafts and columella-plasty, please see the link and the video below

I have flaring nostrils and a hanging columella. What would it cost/how difficult would it be to correct this? (photos)

Answers (7)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: I have flaring nostrils and a hanging columella. How difficult would this be to correct?

Answer: I have flaring nostrils and a hanging columella. How difficult would this be to correct?

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.

I have flaring nostrils and a hanging columella. What would it cost/how difficult would it be to correct this? (photos)

Answers (7)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: I have flaring nostrils and a hanging columella. How difficult would this be to correct?

Answer: I have flaring nostrils and a hanging columella. How difficult would this be to correct?

Browse related questions

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.