A rhinoplasty, and more specifically a columellar-plasty can be performed when patients have a hanging columella. The hanging columella is usually composed of both bone and cartilage. The cartilage component is the most inferior caudal extension of this nasal septum. A small amount of the caudal septum is composed of the bony nasal spine. Cartilage, bone and skin all need to be adressed to reduce the hanging columella. The columella angle with relationship to the upper lip can also be adjusted upwards or downwards depending upon the angulation of the cartilage removed. To lift the tip, more cartilage and skin is removed from the most superior portion of the columella. To bring the tip downwards requires more cartilage and bone along the nasal spine brought in to cantilever the tip back downwards. Skin is also removed from both sides of the columella as well to tuck the entire septum upwards and inwards. It is also important to release the depressor septi ligament if present, which prevents the tip from drooping when patients smile or talk. Releasing the depressor septi ligament will also prevent the skin from bunching up and showing even more columellar show upon animation. To some degree, the tip can also be lifted at that time if there is a drooping tip present. It is also important to narrow the nasal tip cartilages at the same time if needed to balance with the new columella. Sutures used to close the incision on both sides of the columella are catgut sutures which are dissolvable and fall out in about a week. A columella-plasty can be performed as a stand-alone procedure or it as a component of a full rhinoplasty procedure, depending upon the patient’s desires. Dr. William Portuese is a board certified facial plastic surgeon practicing in Seattle Washington and is the medical director at the Seattle Rhinoplasty Center.
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