The nasal columella is the lowest point of the nose and is the primary framework to support the nasal tip. It comprises two flakes of lower lateral (alar) cartilages that meet at the midline, which attaches to the nasal spine of the upper palate at the inferior end and connects with the nasal septum at the back, to provide a better and stable strut at the nasal base. Besides the functional role of stabilizing the nasal tip, the columella determines the esthetics of the nose by its position and length. Aplasia or retraction of the nasal columella makes the nose appear short and lack a marble-shaped supra-tip and makes the horizontal line of the bilateral alar feet lower than the nasal columella, leading to eccentric physiognomy of the nasolabial angle to less than 90°, so surgery requires the transplantation of abundant cartilage to reconstruct the nasal columella and nasal tip angle; on the contrary, hyperplasia of the nasal columellar cartilage elongates or pulls the nasal columella downward to give the connection between the nostrils and nasal columella an appearance of a sea gull wing and result in nostril exposure or a pseudo-upturned nasal tip. The optional treatment is similar to snub nose correction or nasal columellar retraction targeted at reducing and elevating the nasal columellar cartilage.
Nasal columellar reduction is performed to reconstruct the lower lateral (alar) cartilage without the emplacement of any prosthesis or cartilage to decrease the nasolabial angle from an obtuse angle (more than 110°) to the standard angle of less than 110°. A surgical incision is made based on the severity of the patient’s conditions, either inside the bilateral nostrils (closed method) or at the bottom of the nasal columella (open method). After the lower lateral (alar) cartilage at the midline is separated, the partial cartilage is resected; then, the suture between the lower lateral (alar) cartilage and nasal spine is dissected, and the base of the cartilage is posterosuperiorly fixated at the base of the nasal septal cartilage. In this way, the surgery successfully shortens the nasal columella and restores the nasolabial angle to the standard angle of 100° and improves the partially upturned nose or nostril exposure caused by the prominent columella.