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Rhinoplasty Gallery


                   Dr. Azizzadeh Primary

What is Rhinoplasty?

These pages will have an archive of all the rhinoplasty content and discussion we had on our site. A lot of usefull information will be in these archives. Over 100 pages of content will be added.

Was JT's columella retracted up and as a result there was no columella show from the side. In other words making the vertical length of his nose shorter. Or was it smooshed in too close to his face and he needed projection to push it away from his face. Mine septum was trimmed and before you could see both my columella and some septum from the side. Now there is no columella show from the side or very minimal. I just wanted to make sure we were talking about the same problem. None of my consults had mentioned columellar strut. Yes I need some other things done, my tip is rotated up too much and supratip graft needs to be thinned out.

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He never posted pictures, so I can't tell you exactly what it looked like. JT never mentioned the length of his nose as far as I can remember. He just said his columella was pushed off the spine and it was retracted.

I actually have a similar problem to yours whereas the alar rims and the nostrils are even with the columella so from the side it looks flat when the ideal distance from the alar rim and the columella is supposed to be 2 to 4 mm in profile. I've been told by Toriumi and others long strut and tip graft to increase projection and improve the angle. I was told that the strut in my first revision was used to stabilize the tip in a over-resected nose. It served no cosmetic purpose as far as I could tell or as evidenced by pictures and it was too short to do anything structurally.

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oh ok so 2 - 4 mm of columellar show from the side view is the ideal? And you don't have any columellar show from the side? I am not sure what you meant when you explained what T would do?

My issue is that I want 2 - 4 mm of columellar show from the side but I have very minimal columella show. On some people no columellar show from the side looks normal but on me I need it because with my columella being retracted there is too much space between the top lip and the nose.

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I'm sure there are tons of people who don't fall in the "ideal category" who look fabulous. It's just a number that was quoted to me in a consult and since currently I have zero columellar show from the side and it looks terrible I would have to agree that 2 to 4 would be better.

If you feel your upper lip appears too long it could be because your tip is over-rotated. I also have an over-rotated tip and because you see more nostril and the base of the nose it makes your lip look longer. T's plan was to lengthen or de-rotate) my nose using long spreaders, and add projection with the strut and tip graft. To improve the "flat" profile view, he was going to use a long strut that would change the columella from what looks like straight up and down to more of an angle so that it drops down a bit lower than the alar rim from the side. The tip graft would be attached to the top of the strut so that in profile I would actually have a tip on my nose.

Though our cases sound similar he may not have the same solution becuase they probably aren't identical, though I've corresponded with a few people who needed lengthening and T had the same plan for them. I hope that helps.

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Paloma's columella was very retracted (or way up there), it didn't get much better after the revision. Her nose looked better overall but not that part, I'm not sure if a columella can really be grafted down that far (2 - 4 mm). That and bringing down alars are difficult.

Have you gone to any facial-proportion specialists (not necessarily rhino docs) about a full-face analysis? Sometimes the long distance from nose to lip can be reduced other ways if it really is a problem. I guess what I am trying to say is that the nose isn't always the entire problem or solution, and the rhino-docs are not always up to speed on the full face beauty.

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Thanks for the feedback FP. I don't have to go much further than my pictures before my primary to see the difference the over-rotation made in my lip length. Ideally you shouldn't be able to see your columella from the frontal view. My nose angle went from about 100 in profile to 125.

Not that I spend a whole lot of time thinking about it :) but one surgeon I consulted with said my facial proportions are pretty much within the norm, equal thirds. I agree that Toriumi doesn't corner the market on the lengthening procedure. I can say for sure that my last surgeon, however, didn't have a clue.

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So many don't know what they are doing and won't admit it. Like you I would be very unhappy with that much rotation.

I just don't know if the columella can be fully restored once retracted.

There are plenty of women (usually older) who have trouble with the dreaded lip-to-nose distance, it gets even longer with age (sorry). They usually want their front teeth to naturally show a bit when they part their lips. There are ways to do this lip lifts and lip suspensions but you have to go to someone with experience of course. Well done it can make a huge difference to a face. You may consider something like that in addition to the rhino, to work on that area.

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Yes, everything seems to get longer with age for women. I wish my nose would get longer on it's own and then I wouldn't have surgery:).

Honestly after what I've been through with my nose surgeries, I can't imagine signing up for any more PS. Once this puppy gets fixed, I'm counting my blessings and living with what God gave me. Though I have heard that those techniques you've mentioned can be very successful and make a nice improvement in the proportions.