Definition

Alar retraction is the upward contraction of the ala (or fragment of the nose adjacent to the tip), which leaves a person with an unwarranted nostril show.

Hanging Columella is a condition when a person’s columella (bridge of the tissue that divides the nostrils at the nose base) is placed such that more than 4 mm of the nostril is visible on his/her profile view.

These common features are mainly seen in Chinese from the South-eastern parts of the China. It is important to distinguish between a hanging columella from retracted nostrils as the treatment is different. Often, together with retracted alar, these two features can cause excessive nostril show.

What Can Cause An Alar Retraction Or Hanging Columella?

An alar retraction or a hanging columella can be caused by the following reasons:

• Some people are born with a retracted alar or a hanging columella
• In some patients, alar retraction is the result of previous nose reconstructive surgery
• Hanging columella may be caused by an overly long septum, or previous nasal surgery causing the disorientation of the actual alignment of the columella cartilages

How to Fix Alar Retraction?

Composite grafting is a well-established technique used by surgeons in revision rhinoplasty and cosmetic rhinoplasty to effectively reshape the actual nostril rim in a natural way.

In general, grafting term in the rhinoplasty infers placement of a cartilage segment into a patient’s nose. However, in some cases, the positioning of the cartilage alone is not considered as a desirable solution. For this reason, many rhinoplasty surgeons combine cartilage with the soft tissue and skin in one graft (referred as composite grafting) as a standard rhinoplasty technique for correcting alar retraction.

How to Fix a Hanging Columella?

The hanging columella is frequently the consequence of a combination of a low hanging placement of the medial footplates, an excessive nasal mucosa, and a long caudal septum. This can be cured by both – an open rhinoplasty or a closed rhinoplasty approach – depending upon a surgeon’s preference. Most of the best plastic surgery clinics in Korea use a closed approach (wherein, the incisions are made inside the patient’s nose as against an exterior columella incision), given the fact that the patient is not having other nasal concerns. 

In a closed rhinoplasty, the patient evades a typical swelling at the nose tip that usually occurs in the open rhinoplasty. For this reason, the recovery time is fairly minimal with apparent immediate results.

The goal of correcting a retracted alar and hanging columella is to establish a congruent relationship between the nostril area and other facial features of the patient.