Columella is composed of cartilage and skin. It separates nostrils connecting the nasal tip to the nose base into left and right sides. While aesthetically shaping a person’s nose, the columella cannot be ignored, for instance, in the case of septal deviation, the columella may look crooked and hence needs to be fixed as well.
A retracted columella is referred to an aesthetic condition wherein the nose tip projection appears as retracted or pulled-in when viewed from the front or in profile view. The condition follows as a person’s 2/3rd columella is not appropriately projected or is inferior to the standard alar margin.
A person with this kind of nose deformity is also medically terms as no columellar show as the columella is rarely visible. In general, a retracted columella may make an individual’s nose look overly short for the face as well as may even affect the person’s entire nose shape. To correct this disfigurement through rhinoplasty surgery, nose surgeons lengthen the columella and septum together along with repositioning the cartilage grafts.
This condition is most commonly seen in Chinese, Malays and those of Indochinese descent. It is often due to a weak septal cartilage. This is aggravated by overhanging alar that is also commonly seen in this population. Some of the common causes of the retracted columella are:
Previous Nose Surgery: A number of rhinoplasty procedures can cause the retraction of columella through surgical intervention. This means, a retracted columella is primarily seen as an outcome of a primary or a secondary rhinoplasty technique in which excessive skin or cartilage was removed in the course of the procedure.
Normal Anatomic Disparity: Another cause of a retracted columella is the natural physiological trait of a person.
Congenital Deformity: In some cases, patients have a congenital disorder (like a cleft lip/palate) that leads to columellar retraction.
Nasal Trauma: There are many processes that may cause septal perforation or erosion of the cartilaginous septum, which in turn, may also trigger a columella retraction.
The retracted columella correction in cosmetic rhinoplasty predominately depends upon the identification of the exact causative factor that leads to the defect. For this, the surgeon performs a surgical assessment wherein the patient’s nasal columella is thoroughly examined. Besides, any surgical adjustments to the columella may have extensive functional and aesthetic impact on the nose, so a detailed evaluation is essential.
A columellar retraction is mainly evaluated in comparison to the upper lip and nostril region. If the retraction is caused by a belligerent cosmetic surgery, surgeons will study the pre-procedural images of the patient as a visual reference for the further treatment.
Once the occurrence of a retracted columella is identified and its underlying cause is confirmed, a rhinoplasty surgeon will establish the amount of columella lengthening required to attain a natural and satisfactory outcome. For this, frequently spreader grafts are used. However, the selection of grafting material mainly depends on the anatomical quality of the person’s columella. Depending on the case, a tissue or cartilage composite with rib cartilage or nasal septum may be used by the nose doctor.