Two years post revision - Can my hanging columella be restored? (Photos)

Question

Hello, I had my revision two years ago and my columella was made more straight wMy tip was not altered during my original rhinoplasty, just my dorsal hump shaved). So after revision I am extremely saddened by the loss of my hanging columella. I felt as though it helped cover my philtrum slightly. I just feel so discouraged like no one can help me, my surgeon said we need to leave my nose alone, however, I still don’t like my columella/tip 2 years later. I miss my round tip and curved columella and I want restored

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It is technically possible to derotate a tip or to place a columellar onlay graft to lower the columellar height. Based on your photographs, I would not necessarily recommend that. A more detailed discussion would be helpful to determine your goals. 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. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

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

Randal Haworth, MD, FACS · Answer

I understand the frustration. A columella that shows slightly below the nostril rims is part of what gives a nose its character, and losing that curve also changes how the base of the nose meets the upper lip. Without an exam I cannot say exactly what was done, but a columella usually loses its show and curve when the caudal septum is shortened, the medial crura are straightened or set back, or the tip is rotated upward. When restoration is feasible, it generally means rebuilding support rather than adding filler: a columellar strut or caudal septal extension graft, using cartilage from the septum, ear or rib, can bring the base back down and give it a gentle curve again. Two years out, the tissues have usually settled enough for that discussion, although scar tissue and skin that has been through two operations set real limits on how much can be recovered, and a third operation is a decision to weigh carefully. Wanting to leave a nose alone after two surgeries is a cautious and common position, so a second opinion is a reasonable way to weigh it. I would suggest an in-person evaluation, with profile and base views, by a board-certified surgeon who does a great deal of revision rhinoplasty.

Two years post revision - Can my hanging columella be restored? (Photos)

Answers (2)

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