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Hanging Columella

What is a hanging columella?

The columella is the bridge of tissue that separates the nostrils at the bottom of your nose. Ideally, the columella is positioned so that at most 4 millimetres of nostril is seen on profile view. A nose is said to have increased “columella show” when more than 4 millimetres of the nostril is visible.

Columella anatomy Dr Roth

Hanging and retracted columella1. Normal nose: AC=BC=1-2mm
2. The hanging columella BC>AB>2mm
3. The retracted columella AB>BC>2mm

How does a hanging columella occur?

A hanging columella can be a natural occurrence or it can sometimes happen after a previous rhinoplasty. More often than not it occurs from the patient having an overly long septum.

Can it happen from a previous rhinoplasty?

Unfortunately yes a hanging columella can develop after a rhinoplasty procedure. A columella strut, caudal extension graft, plumping graft or shield graft can all push the columella too far downwards. Another cause after rhinoplasty is due to alar retraction and nostril retraction which causes increased columella show.

How is a hanging columella fixed?

It is important to determine if the increased columella show is due to excess columella tissue or a retracted nostril rim. If the nostril rim is lowered it may need to be lowered.

A hanging columella can be corrected by trimming the end of an overly long nasal septum. The two nasal tip cartilages that sit within the columella can also be moved upward and stitched to the septum. This also creates a very stable nasal tip structure. Some columella skin may also be removed and stitched upwards.

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