An Introduction to Hanging Columella or Ararcolumellar Disproportion

Dr. Michael Menachof Headshot

Dr. Menachof, MD, FACS has performed thousands of facial plastic surgery procedures in over 20 years of experience. He has been recognized as a Fellow by multiple academies, named one of America’s Top Facial Plastic Surgeons continually since 2003 and is featured in multiple national publications.

What is a Hanging Columella?

The tissue and cartilage the separate the two nostrils on the underside of the nose is called the columella. When the columella tissue hangs lower or protrudes below the outer ridges of the nostril, it can appear to be drooping or pointed and may be referred to as a “hanging columella” or alarcolumellar disproportion. Many people who have nasal tissue that hangs lower than their nostrils are unhappy with the way this looks and decide to have a specialized nasal surgery, or columelloplasty, to level the tissue with the nostrils and create a more proportional nose shape.

How Does a Hanging Columella Occur?

Columella CorrectionA 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. Aside from natural occurrences, a hanging columella can also be caused by a mistake in a previous rhinoplasty. This negative result can occur from excessive cartilage resection or nasal retraction. Columellar struts, which are implanted during surgery to support the nose tip, can also be too long, causing disproportionate protruding of the new nasal tip and affecting the look of the columella. If a patient has previously had rhinoplasty surgery, this will be discussed and taken into special consideration during a careful evaluation with your surgeon.

If you have recently had nasal surgery, swelling in the tip or columella may be causing the appearance of a hanging columella. Consult with your plastic surgeon before contemplating another surgical procedure since this may not be the best option for you. Rhinoplasty swelling can occur for many weeks or months following the initial procedure, so talk with your plastic surgeon about ways to decrease your inflammation so you can assess your before and after results without inflammation.

Columelloplasty: The Hanging Columella Nose Surgery

A columelloplasty to fix your hanging columella can be performed alone without altering any other components of the nose. An alarcolumellar disproportion, or hanging columella, can be adjusted by trimming the membranous and cartilaginous tissue. If the cartilage is already retracted, then the surgery will only remove membranous nose tissue. Trimming this lower tissue and cartilage will tuck the columella inward so it will no longer be hanging or pointed. Take a look below to see how the shape of the nostrils and tissue appear before and after the columelloplasty.

Hanging Columella Surgery

No two nasal surgeries are exactly the same, but the goal of the hanging columella procedure is always to improve the relationship and proportion between the columella and the nostrils. By re-shaping the columella, the nose can appear sleek and proportionate from both a frontal and profile view. This was, the columella will align well with the rest of your nasal and facial architecture.

How Much Does a Columelloplasty Cost?

A columelloplasty typically costs less than a full rhinoplasty procedure. There are many variables that affect the exact procedures taking place during your columella surgery. Depending on the techniques used and the extent of the surgery, columella procedures can range between $2,000 and $5,000.

Hanging Columella Correction Recovery Time

The columelloplasty is a closed approach procedure, meaning that the incisions made to remove tissue and fix the nasal issue are on the inside of the nose and nostrils. The sutures used to hold the incisions closed during and after this surgery are dissolvable, remaining intact for about one week after surgery.

There are no bandages or removal of sutures needed after this type of nasal procedure. There may be minor swelling or bruising, so it may take several weeks to see the final result of your columella correction. However, the extent of swelling that takes place after this procedure is minimal compared that of a full rhinoplasty, so the recovery time will be fairly quick and painless.

Ask an Experienced Surgeon About Columella Adjustment Options

The columella provides support to the remainder of the nose structure and is a key aesthetic element of the nasal tip. If you think you may have a hanging columella and desire to make a nasal adjustment, consult an experienced plastic surgeon for a proper examination. They will be able to determine which type of approach and procedure is the best choice for you and your nose.


This blog post was originally published in October 2017 and has been republished in 2020 with updated information. 

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