The Retracted Columella
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The columella, literally meaning small column, is the bridge of tissue separating the nostrils that connects the nasal tip to the nasal base. Composed of skin and cartilage, the nasal columella is the fleshy external portion below the nasal septum – the wall that separates the left and right nasal airways – and forms the base of the nose.
A retracted columella describes an aesthetic condition where the nasal tip appears to be “pulled in” or retracted when viewed in profile and frontal view. A patient with this nasal deformity is also described as having “little or no columellar show.” Because too little of the nasal columella is visible, a retracted columella can make the nose look too short for the face and affect the entire shape of the nose.
Causes of a retracted columella can be the result of different factors, including:
- Previous Nasal Surgery. A variety of rhinoplasty techniques can induce the columella to retract iatrogenically (that is, as an inadvertent result of surgical intervention). A retracted columella is commonly seen as a result of primary or secondary rhinoplasty where excessive cartilage and/or skin were removed during the procedure.
- Normal Anatomic Variation. A retracted columella may be a naturally occurring physiological trait.
- Congenital Defects. Patients who have a congenital condition such as a cleft lip and palate can present with columellar retraction.
- Erosion of the Nasal Septum or Nose Trauma. In addition, numerous processes that erode the cartilaginous septum or cause septal perforation may also cause a columella to become retracted.
Evaluation and Treatment
The treatment of a retracted columella in revision rhinoplasty depends on the proper identification of the causative factor for the defect. During a surgical assessment, the patient’s nasal columella will be thoroughly examined. Any modification to the columella can have far-reaching aesthetic effects and functional impact, so a comprehensive and precise evaluation is necessary. The columellar retraction will be evaluated in relation to the nostrils and the upper lip region. In the case that the retraction is due to an over-aggressive cosmetic surgery, pre-procedural images may be requested as a visual reference for what is possible to achieve with a revision surgery.
Once Drs. Solieman and Litner have confirmed the presence of a retracted columella and identified its underlying cause, they will determine the amount of lengthening that will be required to achieve a satisfactory, natural-looking result. To add length and reconstruct the columella, Drs. Solieman and Litner utilize grafting and repositioning surgical techniques. The choice of grafting material will depend on the particular case and anatomical qualities of the columella. Grafting material can be cartilage or a tissue composite, with the nasal septum, ear, or rib cartilage often being the source of the donated biological material. For cases where columellar retraction is associated with severe shortening and loss of support of the nasal tip, Drs. Litner and Solieman prefer use of irradiated cadaveric donor rib cartilage for reconstructing tip support, a material with which they have great success.