Classifying deformities of the columella base in rhinoplasty

Overview

The columella has been studied from the front and side but rarely from below, where its base meets the lip. The authors examined basal-view photographs of 100 first-time rhinoplasty patients, judged whether the columella base met ideal norms, and built a classification of the deformities by their most likely anatomic cause.

Sections of note

• Retrospective review of preoperative basal view photographs of 100 consecutive primary rhinoplasty patients.
• 16 of 100 (16%) showed ideal columellar aesthetics; 84 (84%) had some abnormality.
• Type 1, caudal septum and/or nasal spine: 18%.
• Type 2, medial crura: 12%.
• Type 3, soft tissue: 6%.
• Type 4, combination: 48%.
• The abstract does not describe the treatment for each type or any outcomes.

What it means for a patient

• Most people seeking rhinoplasty have some irregularity at the base of the columella, usually from more than one cause.
• Knowing the cause tells the surgeon whether to work on the septum, the tip cartilage or the soft tissue.
• The classification comes from photographs in one practice and has not been tested for how it changes results.

Why this paper matters

It brings the basal view into systematic analysis and proposes a cause-based scheme that can standardize how surgeons plan for this region. Validation by other surgeons and links to outcome are still needed.

Terms

• Columella: the strip of skin and cartilage between the nostrils.
• Basal view: the view of the nose from directly below.
• Caudal septum: the front lower edge of the septum, just behind the columella.
• Nasal spine: the small bony point at the base of the septum above the upper lip.
• Medial crura: the inner legs of the tip cartilages that run down the columella.
• Primary rhinoplasty: a first-time nose operation.