Rhinoplasty: Cost, Pics, Reviews, Q&A

Hanging Columella Can Be Fixed By An Endonasal Rhinoplasty Approach

The hanging columella is usually the result of a combination of a long caudal septum, a low hanging position of the medial footplates and excessive nasal mucosa.

It can be repaired through either an open or closed approach depending upon the surgeon’s preference. Given that you have no other nasal concerns, it would make the most sense to limit the extent of the surgery and recovery and use a closed approach.

In reality, a closed rhinoplasty approach means that the incisions are on the inside of the nose as opposed to an external columellar incision. So it is really an open approach done from the inside and is hidden.

This also means that there will not be the typical swelling of the tip of the nose that occurs after a traditional open rhinoplasty, so recovery will be fairly minimal and the results immediately apparent. (Barry L. Eppley, MD, DMD, Indianapolis Plastic Surgeon)

It is possible to elevate the columella with a tongue and groove in a closed procedure. A nylon suture to the septum will elevate the columella. (Paul S. Nassif, MD, Beverly Hills Facial Plastic Surgeon)

Haning columella can be imporved via closed approach

A “hanging columella” is noted when the central portion of the nose (between the nostrils) hangs more than 2-3mm below the nasal rim. This condition can be due to an elongated septum or large nasal spine.

Hanging columella rhinoplasty correction

In either case, it is relatively easy to fix this without performing an incision across the columella (open rhinoplasty). This procedure could potentially be done under local anesthesia.

The surgery would involve partial removal of the anterior septum or nasal spine and partial resection of the mucous membrane. (Theda C. Kontis, MD, Baltimore Facial Plastic Surgeon)

Correcting The Hanging Columella With Open Rhinoplasty

The hanging columella is a condition which can usually be corrected via a closed rhinoplasty approach. Although different situations may lead to excess columellar show, a common cause of hanging columella is excess caudal septum. The septum is the cartilage and boney wall which separates the nostrils.

Hanging columella nose job

If there is excess caudal septum, the cartilage can cause the columella to protrude. The septum can be shaves with a closed rhinoplasty technique, and can then be reset between the medial crura to allow for less columellar show. (Anthony Corrado, DO, Philadelphia Facial Plastic Surgeon)

Correcting a hanging columella

If a hanging columella poses concerns, it is possible to raise the columella with a closed rhinoplasty approach. The decision to complete nasal shaping with an open or a closed approach depends on what is required to shape the tip, contour the bridge, and place any supporting grafts if needed. If the columella is your only issue, the closed rhinoplasty should be right for you. (Peter E. Johnson, MD, Chicago Plastic Surgeon)

A hanging columella is not always recognized in rhinoplasty

Hanging columella rhinoplasty swelling after

A hanging columella is when the area between the two nostrils hangs downward showing too much skin on profile. This can also make a nose look too long.

According to the medical literature, the columella should not hang more than 2 to 4 millimeters below the edge of the nostrils when viewed on profile.

There are a number of ways to treat or reduce a hanging columella, the technique used really depends on the actual cause; which can vary.

I treat hanging columellas through and endo-nasal or closed approach, since I perform over 90% of my primary rhinoplasties closed as well. (Steven J. Pearlman, MD, New York Facial Plastic Surgeon)

In my practice, a hanging columella is best repaired with Rhinoplasty Surgery using an open approach.

Hanging columella rhinoplasty surgery

The best way to repair a hanging columella is to determine the cause. It may be due to your septum being too long. I suspect, in your case, the exaggerated curvature of your columella will require division of your lower lateral cartilages to straighten the medial crurae.

You might also benefit from a columella-strut, cartilage graft for additional straightening. In my practice, an open approach would be used. (Eric M. Joseph, MD, West Orange Facial Plastic Surgeon)

Most rhinoplasties can be performed closed (incisions inside the nose). However, every surgeon is different and you will need to discuss your specific case with your surgeon. (David Shafer, MD, New York Plastic Surgeon)

Hanging columella treatment.

Hanging columella rhinoplasty procedure open or closed approach

For the past 35 years I have treated the hanging columella like yours closed even though I was one of the pioneers of open rhinoplasty. When . In those says almost all surgeons did noses closed and I was considered a heretic. (Toby Mayer, MD, Beverly Hills Facial Plastic Surgeon)

Hanging columella treatment

Treatment if a hanging columella can be done with a closed or open approach depending upon what else needs to be done. If it is just an isolated hanging columella, then it can all be done “closed.” (Steven Wallach, MD, Manhattan Plastic Surgeon)