My Columella Shows, What is the Best Way to Treat It?

Dear Peter,

From the lateral views of your nose (the side profile), it appears that there is excessive columellar show mostly due to a hanging columella. There are two main components that can contribute to this:

-an excessively long or over developed septum (the firm midline cartilage)

-overdeveloped medial crura (the soft cartilages that define the shape of the columella

Both of these can be treated with a rhinoplasty focused on refining the columella. If you are pleased with the appearance of the rest of your nose, then this makes it even more straightforward, and I think it would be very reasonable to achieve the appearance you desire.

The base view of your nose (the one looking from below) shows some asymmetry of the medial crura (the cartilages that shape the columella) and this can be addressed at the same time.

I hope that helps.

Best wishes,

-Dr. Asaria
 

Hi! It does look like your columellar show exceeds the normal 3-4 mm we like to see in an aesthetically pleasing nose. This is a straightforward procedure that can be done with incisions inside the nose, provided you are happy with the rest of your nasal appearance, and nothing else needs to be altered. However, it will give the appearance of a slight shortening of your nose and slight lengthening of your upper lip. Your rhinoplasty surgeon should be able to morph photos to give you an idea pre-operatively of what to expect.

Good luck!

Just have the "hanging" part of the cartilage  removed and that is all you need! This can be done under local anesthesia and you can go to work the next day.

Hi Peter,

It appears that you have a prominent columella due to your caudal nasal septal cartilage.  Trimming of the cartilage should correct your columellar show.  I do not believe that you have alar retraction.  You should only have it "fixed" if it really bothers you.  Choose your rhinoplasty surgeon most carefully. Good luck and be well.

Dr. P

 

This does appear to be primarily due to excess caudal septum and could be manged by trimmin that area. If the medial crura did not retract up then you might need some "tongue in groove" fixation as well to set the alar columella ratio.  See how it looks on your whole face with computer imaging before to get a sense of the change.

It is due to excess caudal septum. I would perform a caudal septal resection among other things, and then assess the nostrils. An alar contouring graft or lateral crural strut grafts may help reposition the ala. However, rhinoplasty is like chess and one move affects the next. This will have to be discussed with your rhinoplasty surgeon and he will determine during surgery what to do. There are a lot of dynamic changes that occur during surgery.

Make sure your choose a rhinoplasty specialist. The best shot at getting your nose right is the first one!

You do appear to have true columellar show where the columella is greater that 5mm's on profile view.  There does not appear to be any alar retraction which is typically caused by Rhinoplasty and over-resection of tip cartilages.  A Columellar tuck would be the most appropriate way to reduce the columellar show, IMHO.  I do this through and isolated incision behind the colunella and in front of the anterior septal angle.