Alar-Columella Relationship Modification

Chapter 29. Alar-Columellar Relationship Modification

Indications: In order to evaluate the alar-columellar relationship, the surgeon must understand the ideal aesthetic norm for this anatomic relationship. From the lateral view, the ideal amount of columellar show has been described as about 2 mm to 3 mm.¹ A line drawn from the apex of the nostril to its nadir should divide the nostril in equal halves. A retracted ala is present when the alar rim is greater than 2 mm from this line (Figure 29-1) and a hanging ala occurs when the ala is within 1.5 mm of this line (Figure 29-2). Likewise a hanging columella occurs when the columella is greater than 2 mm from the long axis of the nostril (Figure 29-3), and a retracted columella occurs when the columella is within 1.5 mm of the long axis of the nostril² (Figure 29-4). It is important to remember that there may be a combination of both alar and columellar abnormalities that contribute to the deformity. Proper treatment begins with identifying the etiology and specifically addressing the cause.

Figure 29-1. Retracted alar rim—Alar margin >2 mm from line.

Figure 29-2. Hanging alar rim—Alar margin within 1.5 mm of line.

Figure 29-3. Overhanging columella—Columella >2 mm from line.

Figure 29-4. Retracted columella—Columella within 1.5 mm of line.

Markings: There are no specific markings on the patient that need to be made for planning. However, the precise relationship between the alar rim and the columella is best evaluated on a standard lateral photograph, and a clear acetate overlay allows measurements to be made that aid in diagnosis.