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About Face

Chapter Eight The Nose The Psychology of Rhinoplasty Patients Expectations Initial Surgery Making the Nose Smaller Saddle Nose Columella Deformity Revisional Treatment Recovery

Columella Deformity

Another request for rhinoplasty comes from patients with what we call “nasal columella deformity.” There is usually more to the columella that meets the eye: it widens near the base and inside the nostrils to connect with muscles that allow it to tense the septum (a membrane inside the nose between the two nostrils) and give it the strength to help support the nasal tip. I specify “usually” more than meets the eye because people with the deformity of a hanging columella show much more of the inside of their nose than they want to.

In a paper presented to the American Academy of Facial Plastic and Reconstructive Surgery, Dr. Jerry J. Halik and I outlined the properties of what might be called the ideal columella. Ordinarily, the two “wings” of the nostrils, known as the “alae”, should be parallel to the line of the columella, creating evenly spaced nostrils. The angle created by the columella and the protruding upper lip should be greater than ninety degrees. The base of the columella should not project out too far, and the upper lip shouldn’t be too short by comparison. Ideally, the columella should, on profile, hang lower than the “alae” by about four millimeters. With a hanging columella deformity, it droops much further. On profile, this can give the appearance of very large, open nostrils.

There are a couple of ways to deal with a hanging columella. The least surgically intensive method is to trim away some of the septum so that less of it is exposed. This won’t work, of course, unless the septum is too long in the first place. The second method is to trim back the “medical crura” - the area where the columella flares out at the bottom to create two saucerlike depressions inside the base of the nose - if they are particularly wide.

There are other problems to do with columella deformities: patients with too wide a columellar base, others with a retracted columella, or a short columella, and those with no columella. As I mentioned earlier, the variety of rhinoplastic procedures is as wide-ranging as the patients who seek treatment. There are at least ten techniques for lengthening the short columella alone.

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