Rhinoplasty Surgery - Lifting a Hanging Columella

Rhinoplasty Surgery - Lifting a Hanging Columella performed by board certified Seattle facial plastic surgeon Dr William Portuese

Hi Dr William Portuese in Seattle. Today we're talking about reduction of the hanging columella with a closed rhinoplasty approach. The columella itself is this portion of the nose right here that is the dividing line from the left nostril to the right nostril and behind the columella is the start of the nasal septum and the septum is that simply the dividing line between the left lane and the right lane of airflow but the hanging columella simply is hanging down too much in this location and gives a bottom-heavy look to the nose. https://www.seattlefacial.com/procedu...

What causes a hanging columella?

The hanging columella occurs from either patients were born that way or it wasn't attended to at the time of a primary rhinoplasty and so a revision rhinoplasty is sometimes required to reduce the hanging columella and the reason that the hanging columella occurs after a primary rhinoplasty is because once you shave the hump down the columella itself tends to bowstring downwards or become more bottom-heavy of a look on the nose so when we take the hump down we also have to adjust the columella and we do that by trimming back a little bit of the excess cartilage and excess skin in that location so that it doesn't look like the inside skin of your nose is hanging on the outside And the columellaplasty is usually a integral component of a rhinoplasty procedure it can be done as a standalone procedure but as usually as as a part of a full rhinoplasty.

What causes a hanging columella?
Based on where I take the extra skin and cartilage out of the columella I can rotate the tip upwards or I can rotate the tip downwards depending upon what we're trying to accomplish some patients just want to reduce the total hanging columella so we just reduced reduce that equally but I can lift the tip or D rotate the tip downward when needed


What is surgery like?

The columellaplasty itself can be performed as a stand-alone procedure but it's most commonly performed as part of a run a full rhinoplasty procedure the surgery is performed under general anesthesia by a board-certified physician anesthesiologist here in our Medicare certified outpatient surgery center for patient safety and comfort


What is recovery like?
After a columellaplasty the cast is applied across the bridge of the nose the sutures are dissolvable the cast comes off in about a week anticipating about two weeks of visible bruising and swelling after the surgery patients notice their reduction in the hanging columella immediately even with a cast on they notice how their columella has been tucked in and it's not so prominent and then they get about two weeks of bruising and swelling full healing on the nose takes about a year however about 70 percent of the swelling has gone on a month and about 90% of the swelling's gone at about three months after the surgery. This is a closed rhinoplasty procedure where all the incisions are placed on the inside of the nose no external incisions are required no packing is placed on the inside of the nose

Can you walk us through a patient who had a hanging columella.

So this patient has what's called a hanging columella she literally has over a quarter of an inch of skin nasal skin hanging out of the outside of her nose and it just gives her a very bottom heavy look a short upper lip and it just just it's just not balanced it's this nose is out of balance so I went in through a closed round of plastic approach I also shaved down a little bit of a dorsal hump and removed cartilage and skin from inside her nostril along her columella to give her more alar columella relationship that's much more pleasing and aesthetic so that her nose looks much more balanced rather than so rather than being so bottom heavy in appearance what I like to see is that the patients get such a significant improvement but it looks very natural and it doesn't look like they've ever had a rhinoplasty they just look better but nobody can quite understand quite figure out why they look better the key is to is to not draw attention to the nose the key is to draw attention to the whole facial features and make sure the nose is balanced but what we're trying to do is make the nose look less prominent so that I'm trying to blend the nose in so that people look past the nose and not then not there's just not a detractor like that that's just kind of the focus
what draws your eyes right to it

Dr William Portuese
1101 Madison St #1280
Seattle, WA, 98104 USA
206-624-6200
https://www.seattlefacial.com
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