What Is A Hanging Columella?
The columella is the bridge of tissue that separates the nostrils at the nasal base. Ideally, the columella is positioned such that at most 4-mm of nostril is seen on profile view. A nose is said to have increased "columellar show" when more than this amount of nostril is visible.
What Can Cause a Hanging Columella?
There are several possible causes of a hanging columella. Some patients are born with a hanging columella. Often this is secondary to an overly long septum that pushes the columella downward. In other cases the actual orientation and positioning of the columella cartilages (medial and intermediate crura) are the cause.
The patient above came to me regarding nasal congestion. He was incidentally noted to have a naturally hanging columella that he wished to have improved. From his exam I could see that his overly long septum was the cause of the problem. Using a closed approach I used a tongue-in-groove setback approach to treating the hanging columella. Similar to tongue-in-groove joinery in carpentry, this involves separating and advancing the two nasal tip cartilages that form the columella upward onto the septum. These cartilages are then sutured to the septum creating a stable, durable nasal tip. Another option is to resect some of the the columella and then suture the columellar cartilages upward.
Hanging Columella Due To Previous Rhinoplasty
A hanging columella can also be due to prior rhinoplasty surgery. A columellar strut or caudal extension graft that protrudes too far can push the columella downward. Other causes include an overly thick shield graft or plumping graft. Bowing and malpositioning of the columellar cartilages can result from a loss of tip projection after surgery. Unfortunately, a relative hanging columella can be seen quite commonly after rhinoplasty due to excesive cartilage resection and alar retraction which causes increased columellar show.
This patient has increased columellar show due to a combination of a hanging columella and alar retraction. In this patient's case the hanging columella was due to medial crura malposition and a long septum. During his revision rhinoplasty I removed the strut and performed a tongue-in-groove setback in addition to improving the alar retraction. You can read more about this patient's revision rhinoplasty surgery here.
More Hanging Columella Corrective Surgery
The patient shown below has a hanging columella due to a combination of a prominent infratip lobule (due to loss of tip projection) and scar tissue that pushed her medial crura downward.
During her revision rhinoplasty surgery I excised the scar that had formed in the area and repositioned the plunging intermediate crura to create a more balanced, natural tip. You can read more about this patient's hanging columellar revision rhinoplasty surgery here.
Want to learn more about rhinoplasty surgery or see more before and after rhinoplasty photos? If you have a hanging columellar and want to see what can be done contact us here to set up an consultation.