I recently saw one of my postoperative revision rhinoplasty patients in follow-up and it reminded me of several discussions that have taken place online regarding a hanging columella. This particular patient had prior rhinoplasty surgery by another plastic surgeon. One of her remaining concerns following surgery was the position and shape of her columella. The columella refers to the column of soft tissue and cartilage that divides the two nostrils. In her particular case, it was simply too heavy and brought unwanted attention to this area of her nose. Many people with this particular problem inquire whether or not this type of revision rhinoplasty can be done under local anesthesia. The answer is – yes. Over the years I have performed many revision rhinoplasty procedures for this exact indication and have successfully done this under local anesthesia or local anesthesia with very light sedation.
This particular patient here had hers done in under 45 minutes using a closed approach. This means that there were no external incisions made on the nose. An incision was made on each side of the columella to allow adequate exposure of the underlying anatomy. I then tucked up the cartilage and soft tissue with permanent sutures. The end result of this type of revision rhinoplasty was a subtle yet noticeable improvement in her tip and columella. Her nose now looks much softer overall and she is quite happy with the change.
To see other photos from her revision rhinoplasty, use this link here: https://www.drhilinski.com/gallery/revision-rhinoplasty/patient-39#content