A hanging columella often occurs naturally in patients as normal result of nasal growth. This tissue can hang too low because of a disproportionately long septum, or because of the positioning and orientation of the nose cartilages.
A hanging columella can be corrected by trimming the end of an overly long nasal septum. The two nasal tip cartilages that sit within the columella can also be moved upward and stitched to the septum. This also creates a very stable nasal tip structure. Some columella skin may also be removed and stitched upwards.
Answer: Hanging columella
This would require a revision rhinoplasty to be corrected with long-lasting results. In general, correcting a hanging columella is "easier" than correcting retracted alae. I suggest you see a revision rhinoplasty expert for further assessment and to discuss the best treatment options for you.
Bowing and malpositioning of the columellar cartilages can result from a loss of tip projection after surgery. Unfortunately, a relative hanging columella can be seen quite commonly after rhinoplasty due to excessive cartilage resection and alar retraction which causes increased columellar show.
SURGEON PROFILE
A retracted columella (the lower part of the nose appears unusually high) can usually be improved with a columella graft. This is accomplished with a strip of cartilage taken from the septum and placed into the retracted portion to push it into a more natural appearing position.
Definition. Columella extending inferior to the level of the nasal base, when viewed from the side. [ from HPO]
The ideal alar-columellar relationship is 2–3 mm of columellar show in the lateral view. Excess columellar show is associated with a hanging columella or a retracted ala. The distance from the long axis of the nostril to either the alar rim or the columella roll should be 1–2 mm.
As the initial swelling settles out over the first few weeks, the dorsum begins to settle, the tip starts to soften, and the columella swelling begins to dissipate. The nose continues to settle over the next few months as the edema finally escapes and the soft tissues adapt to their new underlying framework.
Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue.
To promote columella support and tip projection, the study filler was then injected into the columella at an entry point just superficial to the caudal septum and medial crura. To correct the nasofrontal angle, the position and height of radix, the study filler was injected at 1 entry point.
A hanging columella refers to an overly prominent columella – the column of tissue that sits between the two nostril openings. This ethnic, female patient from San Diego desired to have her heavy columella reshaped at the same time as her bridge was made straighter and her tip was defined.
A columellar strut is used to add support to the tip of the nose, lifting a sagging columella, and can help avoid destabilization of the tip of the nose. This graft also helps to avoid nasal airway obstruction. It acts as a means of unifying the nasal tip and controls any nasal-tip sagging.
Cartilage, which covers and cushions the surface of joints, generally does not regenerate once damaged, but "cartilage cells from the nasal septum (the part of the nose that separates the nostrils) are known to have a great capacity to grow and form new cartilage."
It will improve month by month and you will notice it less and less. At this early stage, please do not be concerned about how your incision looks, and remind yourself that the lifetime of a scar is one year. That's how long it takes to completely heal.
Six components of the hanging columella have been identified: the caudal septum, medial crura, columellar skin, membranous septum, anterior nasal spine, and depressor septi nasi muscle.
Wiggle your nose to strengthen the nasal muscles and massage it for five minutes every day. Deep inhaling and exhaling, smiling, and other nose-slimming exercises all help to reduce sagging and make the nose appear shorter, straighter, and sharper.
Rhinoplasty can influence the appearance of the upper lip and make it look longer, but it does not actually change the height. If you express interest in making your upper lip more visible, your facial plastic surgeon may rotate or change the position of the nasal tip during a rhinoplasty procedure.
Your nose grows throughout childhood and your teen years. It may even grow a bit during early adulthood. But after that, any changes you notice are not related to nose growth. Instead, they're the result of changes to your skin and cartilage that alter the shape of the nose.
Cartilage Changes
Another point worth mentioning is that parts of your nose continue growing throughout your life. Your bone stops growing after maturity. But the cartilage may continue growing and changing throughout your life.
Tip plasty is perhaps the most difficult aspect of rhinoplasty. Several methods are used to correct the tip.
Scar tissue and weakened internal structures make working inside the nose extremely challenging. Only the most experienced and talented surgeons perform this procedure, as it is extremely complex. Many patients are extremely nervous before revision rhinoplasty, but the positive changes can be dramatic.
The tip takes the longest time to heal and mold to the new framework because it's the thickest skin of the nose.
A normal amount of columellar show is generally considered to be between 2 and 4 mm. Increased columellar show can occur for two basic reasons. The first is that the nostrils are retracted, or lifted up. The second is if the columella, the portion of the nose between the nostrils, is hanging downward.
The nasal septum contains bone and hyaline cartilage. It is normally about 2 mm thick. The nasal septum is composed of four structures: Maxillary bone (the crest)
The space between the upper lip and nose is called the philtrum. The ideal length of the philtrum is roughly a half-inch (11-13 millimeters) for women and a couple millimeters longer for men. At that length, when your lips are relaxed, the tips of your teeth should be visible.