Columella Drooping Surgery is essentially a surgical intervention aimed at correcting the drooping of the thin, supportive tissue located underneath the nose, between the two nostrils. Sometimes it is performed purely for aesthetic purposes, while other times it addresses functional problems such as nasal congestion. The goal here is to make the columella region—considered the “main pillar” of the nose—more symmetrical, more robust, and in harmony with the overall facial structure. By refining the sagging or overly elongated part of the lower nose, this procedure not only provides a more attractive appearance but can also improve the nose’s breathing functions.
What Is Columella Drooping Surgery and How Does It Work?
If we imagine the base of the nose, this region acts like a “bridge”: between the two lateral cartilages (alar cartilages), there is a column of tissue where the lower end of the septum’s anterior portion meets. This column is called the “columella” in medical terminology. The term “drooping” refers to this column being positioned lower than normal or being excessively elongated. In some individuals, this appearance is genetically prominent; in others, it can be caused by previous rhinoplasty procedures or trauma.
During a columella drooping surgery (columelloplasty), the surgeon reshapes this tissue area under the nose. The essence of the procedure is to pull the “droopy” portion upward or to shorten the elongated cartilage by trimming it. In some patients, the source of the problem may be excess cartilage within the nose (for example, the caudal end of the septum), while in others, the middle portion of the nasal tip cartilage (the medial crura) may be weak or misplaced. The surgeon’s task is first to identify the exact source of the problem, then apply corrective maneuvers accordingly.
For instance, if the problem arises from an overly long caudal septum, that extra length is surgically shaved or removed. If the medial crura fail to provide enough support or are positioned at an incorrect angle, then “suture techniques” or small cartilage grafts may be used to reinforce this structure. Sometimes, a method called “tongue-in-groove” is employed, in which the nasal tip cartilages are fixed onto the septum the way a tongue fits into a groove. This gives the columella a tighter, more angled appearance. In short, the surgery involves locating the anatomic source of the issue and making precise adjustments accordingly.
Why Does Columella Drooping Occur?
Columella drooping, also known as “columella ptosis,” can develop for many different reasons. Some are present from birth; others appear later in life. Understanding the source of the drooping largely determines how it will be treated.
Congenital (Birth-Related) Causes:
Some people are born with a genetically inherited long septum or with cartilage structures that develop at a certain angle. If the lower (caudal) septum grows longer than normal or if there is a “C”-shaped curvature in the lower nasal cartilages (especially the medial crura), the columella may be pulled downward over time. This is akin to a “built-in” condition; even as an individual’s facial anatomy matures during adolescence, a drooping appearance can develop.
Post-Surgical or Trauma-Related (Iatrogenic or Acquired) Causes:
If you have previously undergone a rhinoplasty and, during that surgery, too much cartilage was removed, supports were placed incorrectly, or unexpected scar tissue formed during healing, the columella may lose support and begin to droop. This is especially likely if a large amount of the alar cartilages at the nasal tip were removed, making the columella look like the lowest point of the nose.
Another factor is what’s called a “pseudohanging columella.” In this scenario, the columella is actually in a normal position; however, if too much tissue was removed from the alar cartilages (lateral crura), the nostril rims are pulled upward, making the columella appear droopier than it actually is—a sort of visual illusion.
Other Structural Factors:
Some people do not have sufficiently rigid or strong nasal cartilages, which can weaken the support of the nasal tip. Over time, under the influence of gravity, the column under the nose can droop further. Aging, connective tissue weaknesses, or past injuries can also exacerbate this picture.
Environmental and Personal Factors:
Habits such as smoking, poor nutrition, or frequently manipulating the nose can affect tissue healing capacity, creating a predisposition for drooping. Typically, these factors alone do not cause significant drooping; however, they can amplify an existing tendency.
How Is a Drooping Columella Diagnosed Before Surgery?
For an experienced nasal surgeon, simply looking at a patient is often enough to diagnose a drooping columella. However, there is “more than meets the eye,” and a detailed evaluation is essential. The following steps are involved:
Clinical Examination and Facial Analysis: First, the doctor examines the patient’s nose from the front, from the side, and from underneath (basal view) to measure how far below the alar cartilage edges (nostril rims) the columella extends. Typically, a “columella show” of more than four or five millimeters raises concerns about drooping. The nasolabial angle (the angle between the columella and the upper lip) is also evaluated. A very steep or very flattened angle may indicate drooping.
Patient History and Previous Surgeries: Previous surgeries, traumas, or illnesses affecting nasal structure are assessed. If the patient had a rhinoplasty before and later developed columella drooping, this points to “iatrogenic” causes. Functional complaints, such as difficulty breathing, are also considered.
Photographic Documentation: Photos taken from various angles of the nose, particularly the underside view, are very valuable for diagnosis. These photos are also used for comparing pre- and post-surgery results. Moreover, 3D simulations or simple computer programs can be used to create a more detailed surgical plan.
Imaging Methods: Usually a plain X-ray is not sufficient; however, in some cases, a CT (computed tomography) scan may be done to see the septum’s position, the size of the cartilages, or any bone deviation more clearly. Imaging is especially helpful if a mass or anatomical anomaly is suspected in the nasal structures.
Palpation and Internal Examination: The doctor palpates the lower part of the nose to gauge cartilage firmness, thickness, and any elongated sections. An endoscopic examination of the nasal interior also helps assess where the septum ends and how the columella interacts with it.
Who Is an Ideal Candidate for Columella Drooping Surgery?
Not everyone is suitable for every nasal surgery; hence, to determine if someone is a candidate for “columella drooping surgery,” certain criteria must be met. Some key points include:
Noticeable Drooping or Excessive Elongation: For instance, if you see clearly in the mirror that the tissue under your nasal tip hangs significantly lower than your alar cartilages, or if, viewed from the side, your nasolabial angle is significantly “closed,” these signs may indicate you are a candidate for surgery.
Functional Problems: Difficulty breathing, especially a feeling of narrowing at the base of the nostrils or actual disruption of airflow, is another reason for surgery. In some cases, a droopy columella can narrow the nasal entrance and affect breathing.
Suitable Health Condition: Individuals without chronic illnesses, uncontrolled diabetes, or serious heart conditions are generally better candidates. Also, since smoking delays wound healing, discontinuing smoking or reducing it to a minimum before and after the procedure is advised.
Realistic Expectations: A columella correction procedure does not instantly give you an entirely different look. Rather, it refines the lower boundary of the nose and improves harmony between the nose and lip area. Patients should understand that surgery moves them toward “better,” not “perfect.”
History of Previous Nasal Surgeries: If the patient has previously undergone one or more rhinoplasties and has since developed columella drooping, a new procedure (revision) can be planned. However, another surgery brings its own complexities, particularly in terms of meticulous planning and locating supportive tissue. Consequently, working with an experienced surgeon is crucial for these candidates.
Which Surgical Techniques Are Used to Correct a Drooping Columella?
Surgical methods in nasal procedures are almost “tailor-made” and vary from one patient to another. The same is true for correcting columella drooping. The surgeon chooses a technique considering the patient’s nasal structure, the degree of drooping, and any accompanying deviations or lack of tissue. Below are some commonly used surgical approaches:
Medial Crura Tuck-Up Technique: The medial crura, which form the central support of the nasal tip, may at times be weak or improperly placed. In this technique, the surgeon uses sutures to “gather” or shape these cartilages upward. You can think of it like rolling up a pant leg that’s too long: pulling the drooping tissue up and securing it. This approach is highly effective for mild to moderate drooping and involves minimal tissue removal.
Tongue-in-Groove (TIG) Maneuver: In this method—described like a tongue fitting into a groove—the nasal tip cartilages (medial crura) are attached with sutures onto the septum or a specially created cartilage groove. This gives the columella a more defined, angled appearance. It is often preferred in surgeries done via a closed approach.
Caudal Septum Resection or Reshaping: Sometimes the issue is only with the excessive length of the lower portion of the septum. In such cases, the surgeon uses scissors or a scalpel to remove this excess carefully, paying attention to millimetric measurements. The goal is to shorten it without compromising the support structure of the nasal tip.
Cartilage Grafts for Support: If the columella is very weak or lacks sufficient support during the procedure, additional cartilage pieces may be required. These are usually harvested from the septum, the ear, or the rib. Such grafts support the drooping area, helping achieve both functional and aesthetic results.
Septocolumellar Suture Techniques: Some surgeons correct the relationship between the nasal tip and the columella using only specialized suture methods and minimal incisions. In these techniques, the septum and the medial crura are pulled in different directions and stabilized. Thus, it is possible to “sculpt with sutures” without extensive resection.
Other Possible Interventions: If there is also a dorsal hump, bone osteotomies or nasal hump rasping may be planned. A prominent hump on the nasal bridge can make a drooping columella stand out even more. Surgeons often prefer to address such aesthetic and functional issues in a single session.
Is Open or Closed Rhinoplasty More Suitable for Columella Drooping?
In nasal surgery, there are two main approaches: Open (external) rhinoplasty and Closed (endonasal) rhinoplasty. When dealing with columella drooping, each has its own advantages and disadvantages.
Open Rhinoplasty: A small incision is made on the skin between the nostrils (the columella), the nasal skin is lifted, and the cartilage-bone structure is fully exposed. Because it offers a broader surgical field of view, this method generally provides more control in complex deformities. If columella drooping is severe, if major changes are needed in the nasal tip cartilages, or if the nose has undergone many surgeries before, the open method may be chosen. Its downside is that there might be a small scar at the incision site, but with good healing, this scar can become very inconspicuous over time.
Closed Rhinoplasty (Endonasal Approach): Incisions needed to correct the nasal tip and septum are made inside the nostrils. Thus, there are no visible incisions from the outside. In some cases, the recovery period after surgery may be more comfortable. The closed method can yield effective results in patients with mild or moderate drooping. However, the surgeon’s field of view is more limited compared to the open method, posing a disadvantage in complex cases.
What Is the Recovery Process After Columella Drooping Surgery?
The success of a procedure depends not only on what happens during the operation but also on proper post-operative care. After columella drooping surgery, there are some common aspects of the recovery process:
First Few Days – Rest and Swelling Control: After surgery, some swelling (edema) and mild bruising around the nose are normal. This can be more noticeable if an open approach was used, although it varies from person to person. Keeping the head elevated, applying cold compresses, and avoiding sudden bending for the first 48 hours can help reduce swelling.
Nasal Packing or Support Materials: If the septum was also corrected, the surgeon may place short-term packing or silicone splints for stabilization and bleeding control. They are usually removed within 2–7 days. These materials can make breathing difficult initially, but once removed, you generally feel relief.
Sutures and Dressings: If an open rhinoplasty was performed, any fine sutures visible on the outside may be removed around 5–7 days post-surgery. In closed rhinoplasty, the sutures are generally absorbable. Regardless, performing regular dressing changes or internal nasal cleaning as recommended by the doctor is essential.
Returning to Daily Life: You can usually resume office work or light daily activities in about a week. However, you should avoid strenuous exercise, swimming, or any activities with a risk of nasal trauma for at least 4–6 weeks. Tissue healing is a delicate process, and protecting the nose is crucial.
Subsiding Swelling and Revealing the Final Shape: The first 2–3 weeks post-surgery are when visible swelling and sensitivity are at their peak. This swelling gradually decreases. However, it can take 6 months to 1 year for the nose to fully “settle” into its final shape. Because the nasal tip and columella region are made of delicate, mobile tissue, they will acquire a more natural appearance over time.
Achieving Emotional and Aesthetic Balance: Many people want to see “perfect” results immediately after nasal surgery, but the nose goes through various stages during recovery. In particular, swelling in the nasal tip and columella can fluctuate. Patience, attending follow-up appointments, and adhering to your doctor’s recommendations are vital at this stage.
Are There Any Risks or Complications in Columella Drooping Surgery?
As with all surgeries, there are certain risks and complications associated with columella drooping surgery. Yet, these possibilities can be greatly reduced with an experienced surgeon and careful surgical planning. It is still important to be aware of them:
Bleeding and Infection: Mild blood leakage post-operation is considered normal, whereas severe bleeding is very rare. The risk of infection is kept quite low through proper sterilization and antibiotic measures.
Insufficient Support or Excessive Resection: If too much cartilage is removed from the nasal tip or if the septal support is overly reduced, nasal tip drooping or alar rim deformities can appear. Conversely, insufficient intervention may result in incomplete correction of drooping.
Scarring: Because open rhinoplasty uses a small incision on the columella, there is a chance of a fine scar in that area. While this scar typically fades over time, it can occasionally become noticeable depending on skin type. Also, internal or side scarring could affect airflow and potentially cause aesthetic asymmetry.
Sensory Changes and Numbness: Particularly with the open approach, numbness or tingling in the columella area or nasal tip during the first weeks is normal. For most patients, this resolves within a few weeks. In rare cases, permanent changes in sensation may occur.
The Need for a Second Revision Surgery: The need for revision is a possibility in any nasal procedure. If the desired result is not fully achieved after columella drooping surgery or if an unexpected issue arises in another part of the nose, another intervention may be necessary. Typically, surgeons wait at least 6–12 months after the initial procedure to consider revision, so that sufficient healing time has passed.
Breathing Difficulties: Sometimes a breathing problem that did not exist before surgery or was previously mild can become more evident afterward. In particular, procedures on the septum or incorrectly placed cartilage grafts can narrow the nasal passages. Such issues, if identified early, can often be corrected with additional procedures.
Op. Dr. Yunus Kaplan was born in Iskenderun in 1979. He graduated from the Gaziantep University Faculty of Medicine in 2001 and completed his specialization in Otolaryngology in 2009. He has worked at various public and private hospitals. Since 2020, he has been accepting patients in the field of rhinoplasty at his private clinic in Istanbul Nişantaşı.
