Wanting a plunging tip/ hanging columella Rhinoplasty Revision. (photos)

Question

It's now a year since my rhino, when the cast was removed I noticed right away that my hanging columella issue had not been addressed, all though I was happier to have a narrower and not so flat nose, I still felt that my nose was still very triangular. The doctor said to wait for the swelling to go down. So now that it has settled, it's not pinched as much and the tip still hangs, and worse when I smile my nose becomes wider and the tip plunges. Pls, provide some suggestion for a revision.

Jamil Ahmad, MD · Answer

It sounds like you have a plunging tip. The nasal tip may be underrotated and typically lacks tip support so that when you smile, the tip plunging is exacerbated and more obvious to you. In many cases, improving tip support with sutures and the addition of cartilage in the form of a columellar strut can significantly improve tip support and help to address your concerns. The columellar-labial angle (angle between the columella and upper lip) and the columellar-lobule angle (angle between the columella and lower half of the tip) may also need subtle adjustment to increase tip rotation and improve tip shape to help correct a hanging or droopy tip. If there is an active depressor septi nasi muscle, this may need to be divided to help decrease dynamic downward movement of the tip during smiling and can also help to decrease the degree of shortening of the upper lip during smiling. All of these changes can help to correct the appearance of a plunding tip.

Kenneth Hughes, MD · Answer

I think that your goals are reasonable for revision.  I would perform this in closed fashion.Kenneth Hughes, MDLos Angeles, CA

John Frodel, MD · Answer

While nothing can be guaranteed, you appear to be an excellent candidate for revision rhinoplasty, in order to shorten your nose appropriately.  Visit with a surgeon experienced in revision procedures to discuss your goals and he/she can make recommendations for you.

Steven Wallach, MD · Answer

It is difficult to tell form the photos that you posted. It is best to be seen in person to get a better appreciation of your concerns.

William Portuese, MD · Answer

The plunging tip is best addressed by releasing the depressor septi ligament that pulls the tip down with animation. Additional cartilage surgery of the nasal tip may be required to lift it. The hanging columella is addressed with a columellar-plasty  which involves trimming back skin and cartilage on the inside of the columella tuck it inwards. For many examples, please see the link below  to our rhinoplasty photo  Gallery

Wanting a plunging tip/ hanging columella Rhinoplasty Revision. (photos)

Answers (5)

Answer: Hanging columella

Answer: Hanging columella

Answer: Revision rhinoplasty for plunging tip and hanging columella

Answer: Revision rhinoplasty for plunging tip and hanging columella

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Everything you need to know about Revision Rhinoplasty

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Wanting a plunging tip/ hanging columella Rhinoplasty Revision. (photos)

Answers (5)

Answer: Hanging columella

Answer: Hanging columella

Answer: Revision rhinoplasty for plunging tip and hanging columella

Answer: Revision rhinoplasty for plunging tip and hanging columella

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.