Restoring the drooping tip and hanging columella in revision rhinoplasty

Abstract

A drooping or ptotic nasal tip can be congenital, iatrogenic, or related to the changes of the aging nose. Commonly, it can be the result of an inadequately performed rhinoplasty. In addition to the unappealing cosmetic outcome, a ptotic nasal tip can also result in nasal obstruction as a consequence of compromised nasal airflow due to the dependent position of the tip. Proper alar-columellar proportion is also of paramount importance when contemplating revision rhinoplasty. A hanging columella can occur both in primary and revision rhinoplasty. Proper diagnosis of this condition requires a fundamental understanding of the normal alar-columellar relationship and being able to distinguish between a hanging columella and a retracted ala. In addition, the expert rhinoplasty surgeon must be able to diagnose the etiology of the hanging columella prior to embarking upon a treatment plan. This chapter highlights the pertinent anatomy, etiology, and treatment for both the drooping nasal tip and hanging columella specifically as it pertains to revision rhinoplasty.