How To Fix Ararcolumellar Disproportion or Hanging Columella After Rhinoplasty

A hanging columella after rhinoplasty occurs when the tissue between the nostrils, known as the columella, protrudes too far below the outer edges of the nostrils, creating a drooping or pointed appearance.

This condition can happen naturally or as a result of prior nasal surgery. Overly long septum, misaligned nasal cartilages, or complications from previous rhinoplasty procedures, such as excess cartilage removal or alar retraction are common causes of a hanging columella.

The good news is that this issue can be corrected with surgical techniques like columelloplasty. This procedure involves repositioning the nasal cartilages and removing excess tissue, often using a closed approach to minimize scarring.

For those with a long septum, trimming it can relieve the downward pull on the columella, while techniques like the tongue-in-groove method can secure the nasal tip for a more balanced appearance.

Recovery is typically quick, with minimal swelling or bruising, and most patients achieve a more proportionate and aesthetically pleasing nose, both in profile and frontal views.

What the Columella Is and Its Role in the Nose’s Appearance?

The columella is the small, central bridge of tissue that separates the two nostrils at the base of your nose. It is a crucial feature in determining the overall shape and proportion of the nose, as it provides the framework for how your nose sits on your face.

The columella plays a key role in nasal aesthetics because it helps define the balance between the nostrils and the nasal tip. Ideally, the columella should be positioned in a way that it is slightly visible when you look at your nose from the side (profile view).

To understand the columella, we must also look at the nasal septum and the nasal cartilages that support it. The septum is the thin wall of cartilage and bone that divides the two sides of the nose.

It plays a vital role in the structure and function of the nose, not just in separating the nasal passages but also in supporting the columella and maintaining its position.

The medial crura and intermediate crura are two parts of the nasal cartilages that are directly involved in forming the structure of the columella. These cartilages help give shape to the nasal tip and support the columella’s alignment.

If the septum is too long or the crura are misaligned, they can distort the columella, leading to a protruding or hanging columella.

What is The Difference Between Normal Columella & Hanging Columella?

A normal columella is one that is balanced and proportional to the rest of the nose. From a profile view, a well-positioned columella will show a small portion of the nostrils, typically around 3-4 millimeters, creating a smooth and natural flow from the nasal tip to the base of the nose.

On the other hand, a hanging columella occurs when this tissue protrudes too far below the nostrils, creating an appearance of a drooping or overly prominent columella.

This condition may be caused by an overly long septum, which can pull the columella downward, or by misaligned cartilages (the medial and intermediate crura) that push the columella out of alignment.

In some cases, excessive cartilage resection during rhinoplasty or natural anatomical factors can also result in an over-projecting columella. The hanging columella may affect the balance of the nose, leading to concerns about facial harmony and symmetry.

What Are the Causes of Hanging Columella?

Here are the main reasons why a columella of the nose might droop or hang lower than desired:

• An overly long septum is one of the most common causes of a hanging columella. The septum is the central cartilage that divides the two sides of the nose. If the septum is too long, it can pull the columella of the nose downward, resulting in a drooping columella.
• The medial crura and intermediate crura are key nasal cartilages that help form the columella. If these cartilages are misaligned, overly prominent, or plunging, they can cause the columella of the nose to hang lower. This misalignment can create an imbalance in the nasal tip and cause a drooping columella.
• After a previous rhinoplasty surgery, excessive removal of nasal cartilage can weaken the support structures, leading to a hanging columella. This is particularly true if the nasal tip was over-reduced, or if the columella nose became unsupported due to improper graft placement or removal of too much tissue.
• Alar retraction occurs when the outer nostrils are pulled inward, causing a hanging columella to become more prominent. This often happens after rhinoplasty if the cartilages are weakened or not properly supported, leading to a shift in the columella of the nose.
• Some individuals are born with a naturally drooping columella due to genetic factors. In these cases, the columella of the nose may be positioned lower than usual, or the nasal cartilages may be more prominent, causing the columella to hang.
• Grafts such as a columellar strut or caudal extension graft are often used in rhinoplasty to support the nasal tip. If these grafts are placed improperly or protrude too far, they can push the columella nose downward, resulting in a hanging columella.
• As we age, the skin and tissues in the nose can lose elasticity and firmness. Over time, this can cause the columella of the nose to sag, leading to a drooping columella.
• Trauma to the nose, such as a broken nose or injury, can disrupt the nasal structure, leading to a hanging columella. The injury may affect the columella of the nose or the surrounding cartilage, causing the tissue to fall out of alignment.

Who Is a Good Candidate for Columelloplasty?

First, we will discuss who may benefit from retracted columella correction and when columelloplasty is the right choice

Patients with a Hanging Nose or Low Columella

One of the primary reasons people seek columelloplasty is due to a hanging nose caused by an overly pronounced low columella. When the columella hangs too low, it can create an unbalanced appearance, especially in profile.

If you feel that your low columella makes your nose look out of proportion, columelloplasty can help reposition and refine the columella, lifting it to a more desirable position.

Individuals with a Retracted Columella Nose

Another common reason people consider columelloplasty is a retracted columella nose, where the columella is pulled upward or inward. This condition can cause the bottom of the nose to appear pinched or excessively narrow.

If you have this concern, columelloplasty can provide retracted columella correction by repositioning or adding structure to the columella, improving the overall appearance of the nasal tip and widening the nostrils if necessary.

Patients Who Have Had Previous Nasal Surgery

Sometimes, rhinoplasty can unintentionally cause the columella to droop or become misaligned, which may result in dissatisfaction with the nose’s appearance. For those who have experienced this, columelloplasty offers a targeted approach to fix the issue and restore a more balanced look.

People Seeking Proportional Nasal Aesthetics

Columelloplasty is also an excellent option for individuals who are looking for more proportional nasal aesthetics. The skin between nostrils plays a significant role in defining the overall appearance of the nose, and an improperly positioned columella can create an imbalance.

Columelloplasty can help refine this area, lifting and reshaping the bottom of the nose to ensure that the nostrils are in better harmony with the rest of the facial features.

How to Correct a Hanging Columella

Fortunately, there are several ways to correct a droopy columella and achieve a more harmonious and proportional nose. Hanging columella surgery is a common approach to fix a low hanging columella and restore the shape and symmetry of your nasal features.

Now, we will discuss with you the key options and techniques used to perform a columella correction.

Columella Reduction Surgery

One of the most effective ways to address a long columella or deviated columella is through columella reduction. This procedure involves trimming or reshaping the nasal columella to shorten or reposition it, so it no longer protrudes excessively beneath the nostrils.

This technique is often used to treat a low hanging columella caused by excessive tissue or cartilage in the area. By carefully removing the extra tissue, the surgeon can create a more balanced and aesthetically pleasing appearance.

Columella Tuck (Repositioning)

Another approach to correcting a hanging nose tip is the columella tuck. This procedure involves suturing the columella to the underlying structures of the nose to lift it into a more natural position.

The columella tuck can be done in combination with other techniques, such as repositioning the nasal cartilages, to ensure that the nasal columella aligns properly with the rest of the nose. This method is particularly effective for correcting a deviated columella or low hanging columella.

Cartilage Repositioning and Support

In cases where the drooping columella is caused by misaligned or weakened nasal cartilages, repositioning the medial and intermediate crura can help support and elevate the columella.

These nasal cartilages play a significant role in the overall structure of the nasal columella and the nasal tip. By repositioning them, a surgeon can correct the hanging nose tip and improve the appearance of the entire nasal structure.

This technique is often used when the columella is pulled down due to a long columella or an imbalance in the nasal cartilages.

Columella Strut and Grafting

In some cases, a columella strut or other grafts may be used to help support the columella and lift it into place. A columella strut is a piece of cartilage inserted into the nasal structure to provide extra support, particularly when the droopy columella is a result of structural weakness or previous surgery.

By adding a graft to the nasal columella, a surgeon can restore shape, projection, and balance to the nose.

Revision Rhinoplasty for Hanging Columella

If your hanging columella is a result of a previous rhinoplasty, revision rhinoplasty may be necessary to correct the issue. During revision rhinoplasty, the surgeon can assess the cause of the deviated columella or low hanging columella, and perform targeted procedures to fix the hanging nose tip.

This might include cartilage reshaping, columella tuck, or even repositioning of the nasal septum. A columella correction performed during revision rhinoplasty can provide lasting and effective results.

Minimally Invasive Techniques

In some cases, patients may prefer a non-surgical columella correction, especially if the issue is mild. These options may include fillers or injections that temporarily support the columella and reduce its appearance of drooping.

However, these methods are not permanent solutions and are more suitable for patients seeking minor corrections without undergoing surgery.

Recovery and Aftercare After Columelloplasty

• After your columella surgery, you will need to rest for the first few days. It’s important to limit physical activity and keep your head elevated to reduce swelling and promote healing.
• Apply cold compresses around the nasal columella and bottom of nose to reduce swelling and discomfort during the first 48 hours.
• Follow your surgeon’s instructions carefully regarding nasal columella care, especially in the early stages of recovery.
• Expect swelling around the columella of nose, nasal tip, and nostrils. Bruising can also occur but is usually minimal compared to a full rhinoplasty. Swelling can last anywhere from a few days to several weeks, with the most significant swelling subsiding within the first two weeks.
• To help manage swelling, columella tuck or the surgical area should be kept elevated, and you should avoid bending over or heavy lifting for a few weeks.
• Pain management is an essential part of your recovery. Your surgeon will provide pain medication or recommend over-the-counter pain relievers to alleviate any discomfort after columelloplasty.
• It’s normal to experience mild pain, pressure, or tightness in the skin between nostrils, especially as your nasal columella heals, but this should improve as time goes on.
• Keep the surgical area clean to prevent infection. Gently clean the bottom of nose and any incisions with the instructions provided by your surgeon.
• Avoid getting water directly into your nose during the first week and try not to touch or rub the columella area to prevent irritation.
• If you were given nasal saline sprays, use them regularly to keep your nasal passages moist and aid in healing.
• After columella correction, your surgeon will schedule follow-up visits to monitor your progress. These appointments are crucial to ensure that the columella of the nose is healing properly and to address any potential issues early.
• Be sure to attend all follow-up appointments, even if you feel like everything is healing well, to ensure the long-term success of your procedure.
• During the early stages of recovery, stick to a soft and easy-to-digest diet to avoid any discomfort when chewing. Avoid spicy or acidic foods, as they can irritate the sensitive tissues in the nasal area.
• Drink plenty of fluids to stay hydrated, which will help your body heal faster.
• Refrain from strenuous physical activities, including exercise and heavy lifting, for at least 3-4 weeks following columelloplasty to avoid putting strain on the healing area.
• Avoid any activities that could put pressure on the nose, such as blowing your nose or wearing tight glasses. If you need to wear glasses, consider using a nose pad or changing to contact lenses for the initial recovery period.
• Most patients can return to light activities after about 2-3 weeks, but more intensive exercises should be avoided until your surgeon gives you the green light.
• Swelling and minor bruising may persist for a few weeks, but these are typically resolved within a couple of months, revealing the final results of your columella lift.
• Keep an eye out for any signs of complications such as severe pain, excessive swelling, redness, or discharge from the surgical area. If any of these occur, contact your surgeon immediately.
• A retracted columella nose or any other abnormality should be addressed with your surgeon during follow-up appointments to ensure proper healing.
• Even after the initial recovery period, continue to follow your surgeon’s advice for long-term care, such as using sunscreen on your nose to prevent discoloration and sun damage.
• The final results of your columella reduction or columella tuck will gradually become visible over several months as swelling subsides and tissues settle into their new position.