Hanging Columella
Post-operative deformities, both functional and aesthetic, are the main and most common of risks associated with Rhinoplasty Surgery often, and unfortunately, resulting in the need for revision surgery. 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 Expert with the proper specialized training in Rhinoplasty Surgery, years of real experience and consistently proven results. As a double board certified Facial Plastic Surgeon with 18 years of surgical experience, Dr. Slupchynskyj is a highly regarded Revision Rhinoplasty specialist.
One of the most frequent of problems Dr. Slupchynskyj sees in patients seeking him out for their Revision Rhinoplasty 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 Revision Rhinoplasty 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, "pig 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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