What is the difference between an alar retraction and hanging columella ?

What is the difference between an alar retraction and a hanging columella? The ala is the nostril. An alar retraction usually refers to a high notch in the Alar rim. The columella is the structure between the two nostrils consisting of skin and underlying Cartlidge . when this structure hangs too low it is called a hanging Columella. Both an alar retraction and a hanging columella can cause too much of the side of the columella to be visible in the profile. A patient may have one or both of these issues

An alar retraction can be found naturally, but it is often seen in patients who have had rhinoplasty that had too much cartilage removed from the sidewalls of the nose. This is corrected by better supporting the sidewall of the nose. A hanging columella comes from an overabundance of the caudal septum for the most part. This can be trimmed during rhinoplasty to correct it.

Both of these conditions may lead to excessive nostril show. In general, nostril retraction or lifting, may occur to a nostril if too much cartilage is removed during rhinoplasty. A low hanging columella may be more likely to be congenital or associated with a long nasal septum. Thank you! Dr Joseph