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Hanging Columella

Post-operative deformities, both functional and aesthetic, are the main and most common risks associated with Rhinoplasty Surgery often, and unfortunately, resulting in the need for revision. It is critical that patients select a highly qualified Facial Plastic Surgeon for their Primary Rhinoplasty Surgery to avoid any need to undergo one or more repeated surgeries in an attempt to achieve their desired result.

Should surgery result in an aesthetic or functional irregularity, which the patient’s surgeon is unable to properly address, it is again best to consult with a Rhinoplasty Surgeon who has the proper training in Rhinoplasty Surgery, years of real experience and consistently proven results. As a Board Certified Facial Plastic Surgeon with over 20 years of surgical experience, Dr. Slupchynskyj is a highly regarded Revision Rhinoplasty Specialist.

One of the most frequent of problems Dr. Slupchynskyj sees in his revision rhinoplasty patients is a Hanging Columella. This deformity is one of the least complicated to correct, but can often be present in combination with other problems, which a Secondary Nose Surgery specialist is able to uncover and address.

The columella is the soft tissue structure separating and between the nostrils which, at its lowest part, meets the area directly above the upper lip. A Hanging Columella can appear to be actually hanging down much below the rest of the nose. In some cases, patients also complain that their nostrils have retracted and too much of their septum shows, which only accentuates this bothersome and unnatural appearance. Hanging Columella is generally a result of overaggressive removal of nasal tip cartilage known as the lateral cura of the lower lateral cartilage. This can also be the result of under-resection of the caudal septal columella. Post operatively, as scar tissue develops in the area where there was an over-resection of the lower lateral cartilage, contraction occurs pulling back the nasal alae and revealing the Hanging (caudal Septum) columella which all results in an unfavorable and distorted, “pug nose” appearance.

The treatment of this problem can be a combination of reduction of the caudal septum (cartilage and mucosa) with possible alar cartilage grafting in the area where the upper lateral cartilage was over-resected. Modification of the medial crura may also be necessary, depending upon the degree of collumellar show.

The above patient’s Columellar Show was caused by a previous Rhinoplasty procedure with another surgeon, in which the Caudal Septum was under-resected, or under-removed. Dr. Slupchynskyj corrected this by resecting, or removing the portion of the Caudal Septum responsible for the Columellar Show, through a Caudal/Septal incision.

The above patient had a previous Rhinoplasty procedure with another surgeon during which the Lower Lateral Cartilages were over-resected, or over-removed and the Caudal Septum was under-resected or under-removed. The over-resection of the Lower Lateral Cartilages caused Nostril Retraction (also known as Alar Retraction) and subsequently led to Columellar Show. Dr. Slupchynskyj corrected this in an Open Rhinoplasty procedure where he resected the Caudal Septum and used multiple cartilage grafts to the nasal tip, including Strut and Shield grafts, made from Septal Cartilage.

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Dr. Oleh Slupchynskyj has more than 20 years of experience as a Rhinoplasty Surgeon and has performed many Secondary Rhinoplasty procedures to correct complications such as Open Roof Deformity. If you are interested in learning more about Dr. Slupchynskyj or the procedures he performs, please contact his practice today at (212) 628-6464 in New York or (973) 966-1000 in New Jersey.

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    New Jersey Rhinoplasty patient discusses her Nose Job procedure, performed by Dr. Oleh Slupchynskyj.

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