Would trimming down the columella fix my nose or would it require extensive surgery? (Photo)

If you are OK with the rest of your nose, then columellar surgery can be relatively limited. But before doing that I would want to reviews multiple views of your nose including what it looked like before your initial surgery. That way, we can be sure that you will really be getting what you want. Be sure to see a rhinoplasty expert for consultation, and not all qualified surgeons have fees in excess of $20,000.

I can't see the upper half of your nose, bridge, sides, etc, so no comments on that.

As a golden concept: columella never ever "hangs" (unless you are 70-80 old), it is a "columellar show" due to congenital (boxy tips like yours) or iatrogenic alar rim retraction (ascension).

There are many treatment options, not all adequate for the same case, like a newly grafter crural tripod, tongue-in-groove maneuver, tutors grafted, etc; alar retraction needs alar support or rim grafting, articulated, etc.

Plus, your bulbous tip has to be fully redesigned.

It seems to me you were a complex boxy tip case with verticalized lateral cruras an high-end technical requirements... who got a scarcely invasive / conservative type of rhinoplasty.

Seek the advice of a good and experienced structure rhinoplasty surgeon who also gathers background in revisions.

In general, an issue like you have may require surgery. Sometimes a hanging columella like yours is due to a cartilage graft, or sometimes it is simply due to the nasal septum being persistently too long. Please consider meeting with a reputable rhinoplasty specialist for an opinion as what might be best moving forward. Hope this helps. Sincerely, Dr Joseph

I'd love to see a direct profile view, to see more of the tip. From this one angle, it seems as though the tip is standing out prominently beyond the line of the bridge of the nose. That, and what's going on in your columella and where the nose meets the lip do indeed indicate the possibility of a big graft that might be causing most of the problem.

Have to say, a surgeon "brushing off your concerns" is a bad sign; I respect any concerns that a patient has, even if the issues are too small to be corrected surgically. You're the one with the nose! You get to feel however you want about it. This indicates, unfortunately, you should not have him operate on your nose again.

Of course it depends on just what's going on, but almost certainly this would be a real revision. The surgeon would have to get a good diagnosis of what's causing the problem, give you a realistic idea of how much can be improved and how *likely* it is to achieve that improvement. Morphs would help a lot -- you need to see what the surgeon is picturing for the final result, so you can see whether you agree.

Yes columella can be refined with surgical excision of the excess tissue. It is a quick in office procedure done under local anesthesia. Watch the video link to understand it completely.
Regards
Dr. Janjua

Hello and thank you for your question. Based on your photograph, you may benefit from a revision rhinoplasty. Maneuvers for your surgery would include trimming of the columellar base, tip refinement, nasal tip deprojection, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon