Retracted Nostrils/Columellar Show

Retraction of the nostrils, also called alar retraction, can be problematic for patients seeking a revision rhinoplasty. This term refers to the increased curvature of the nostril rims that can give greater visibility to the inside of the nose. In some cases, the nostrils can even appear triangular or “peaked” in shape. The amount of nostril visibility from the side is referred to as the columellar show. A normal amount of columellar show is generally considered to be between 2 and 4 mm.

Increased columellar show can occur for two basic reasons. The first is that the nostrils are retracted, or lifted up. The second is if the columella, the portion of the nose between the nostrils, is hanging downward. This “hanging columella” can be an issue for patients on front view in addition to the side view.

In general, retraction of the nostrils occurs when the lower lateral cartilages are overly weakened or thinned during previous rhinoplasty. Correction of this issue can be achieved with a variety of techniques. For mild retraction, placement of a thin cartilage graft just inside the rim of the nostril can push the nostril rim downward. This graft is called a rim graft and can be taken from the septum, ear or rib. For more severe cases of retraction, a combination graft of skin and cartilage (composite graft) can be taken from the cymba concha of the ear. The skin portion of the graft is turned inside the nostril to lengthen the inner lining of the nose. The cartilage is used to push the nostril rim downward. Harvesting of the graft can be done with virtually no change to the appearance of the ear.

The hanging columella can be addressed by lifting the portion of the tip cartilages between the nostrils (medial crura). This is achieved by placing a permanent suture called a tongue in groove suture, which attaches the tip cartilages to the septum. Depending on the placement of the suture, the tip position can be maintained, rotated upward, brought forward, or set backward (closer to the face).

Contact us today for more details or to book a consultation with Dr. Mehta.