Can my crooked columella be fixed?

Question

I had a rhinoplasty and septoplasty two years ago. My columella was crooked before the surgery and it still is. My surgeon claims that it cannot be fixed and that my septum is straight. Should I get a second opinion?

Bahman Guyuron, MD · Answer

The cocked columella can be the result of one of 2 misalignments. The most common reason is a deviated bottom part of the septum. The second reason is the discrepancy in the hight of the 2 cartilages that join in the center within the columella. If you insert you index finger in the left nostril and the thumb in the right nostril and feel the firm structure behind the columella it can give you an indication whether your septum and nasal spins (the bone behind the columella close to its base) is shifted to the left or not. If so, it means that it is the septum that is the problem. Otherwise the problem is the height of the 2 cartilages. Regardless, it can be fixed by a rhinoplasty surgeon who understands this condition.

R. Stephen Mulholland, MD (retired) · Answer

Dear Pi squared,

Thank you for your clinical post and photograph.  A crooked nose is one of the more difficult
aesthetic concerns to correct over the long-term after cosmetic
rhinoplasty.  Crooked noses generally
occur from deviation of the partition of the nose called the septum.  Septal straightening techniques are
notoriously difficult to hold in position over the long-term, but significant
improvements can usually be made.  The
partition at the base of the nose called the columella may be tilted as it
appears in your case or crooked from a deviation of the lower part of the
septum itself or from malalignment of the two cartilages that support the
columella and form the dome of the nose.

It does appear as if your nostrils are slightly asymmetrical
and the left dome may be higher than the right, which may account for some of
the columellar asymmetry.  Providing a
straighter columella may actually involve a revision rhinoplasty or the tip
itself including the domes and the cartilages that support the tip are aligned
more accurately.  The nasal base may be
adjusted and this may provide some straightening to your columella.  However, revision rhinoplasty is fraught with
uncertainty and results may not be any straighter than the subtle columellar
angulation that you currently present with.

You must weigh the options carefully, seek out the advice of
your original operative rhinoplasty surgeon and if they’re not confident seek
the advice of others with significant cosmetic rhinoplasty experience.  I was fortunate to be trained in both plastic
surgery and ear, nose, throat, head and neck oncology and aesthetic rhinoplasty
has been an important part of my practice for over 20 years.  This small degree of columellar imperfection
needs to be carefully planned and executed if you hope to achieve some
improvement.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Can my crooked columella be fixed?

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Can my crooked columella be fixed?

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Everything you need to know about Rhinoplasty

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