Revision Rhinoplasty Surgery For Drooping Columella and Upturned Nose Tip!
A male patient who had a rhinoplasty operation 1 year ago applied for treatment because his columella was hanging downwards and the tip of his nose was pointing upwards when viewed from the side, and his nose had a feminine appearance when viewed from the front. As a result of the patient's examination, it was determined that the columella was sagging and the tip of the nose was pointing upwards (columella-lobular angle was greater than normal). We planned a simple open technique revision rhinoplasty operation for the patient.
As seen in the image above, an incision was made in the columella area that was cut in the previous surgery. The upper and lower skin was dissected and excess cartilage tissue was resected. The nasal tip skin was dissected and removed. The posterior part of the cap graft was shaved and grafts were placed below the alar dome point, due to the reduction of the columella lobular angle. The skin was laid back and sutured with 5/0 rapid Vicryl.
If only the colmella area had been shaved in this patient's treatment, a short nose would have occurred. By extending the tip of the nose downwards, it can contribute to both making the sagging columella less visible and making the nose longer without shortening.
Hanging Columella Definition
Hanging columella is a condition that may occur after rhinoplasty surgery or at birth. Columella, the name given to the tissue between the nostrils, may sometimes sag downwards after rhinoplasty surgery. This may be due to the positioning or orientation of the cartilages at the tip of the nose. In addition, incorrect placement of grafts used in rhinoplasty surgery may also cause this situation.,
Columella Lobular Angle Definition
Columella Lobular Angle is an angle that shows rotation at the tip of the nose. This angle is the angle between the columella and the lower part (infratip lobule). The ideal columellar lobular angle is 30 to 45 degrees. A good nose job is achieved by taking this angle into consideration in rhinoplasty surgeries.
Causes of Hanging Columella
Causes of hanging columella include:
Congenital: Some people may have hanging columella from birth. This condition is usually caused by the septum being too long and pushing the columella downward.
Rhinoplasty surgery: Incorrect placement of the grafts used in rhinoplasty surgery or incorrect positioning or orientation of the cartilages at the tip of the nose may also cause this condition.
Treatment of Hanging Columella
There are several options for fixing hanging columella. These include, after placing a cartilage graft in the lower part of the nasal septum, suturing the cartilages in the columella upwards (as in The Tongue-in-Groove Technique in Septorhinoplasty (TIG)- this technique is very successful in the treatment of correction of the excessive columellar show) and pushing the columella upwards, cutting the columella and sewing the cartilages upwards, or reshaping the cartilages at the tip of the nose.
May Additional Cartilage Graft Be Required in Revision Rhinoplasty for Hanging Columella Treatment?
Although it is a simple revision rhinoplasty procedure, not only cartilage resection but also various cartilage graft applications may be required in order to push the sagging columella upwards. For the smooth cartilage graft to be placed in the lower part of the patients' septum, a rib graft may need to be used. It is especially necessary in patients who do not have enough septum cartilage left. In the patient above, only the cartilage in the columella was shaved; Various cartilage graft applications were also made to the lower front part of the nose tip.
1 Week After Surgery
In the video above, you can see the photos obtained 1 week after the simple revision rhinoplasty operation.
Link group where you can read articles about Hanging Columella previously published on this website >> https://www.ent-istanbul.com/search?q=Hanging+Columella
Source links >> Thieme E-Journals - Facial Plastic Surgery / Abstract / Revision Plastic Surgery: Revision Rhinoplasty: With Introduction of a Novel Preoperative Assessment Classification System - PMC (nih.gov) / Revision Rhinoplasty after Open Rhinoplasty: Lessons from 25... : Plastic and Reconstructive Surgery
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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