Outcome-based Comparative Study to Examine the Correction of Columella Deformitiesfollowing Rhinoplasty

Uppal R, Yousif AH, Maheshwari K.

PubMed 32802685 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 50 endonasal against 15 open rhinoplasty patients, correction of the columella was achieved in 90 percent of the endonasal group versus 67 percent of the open group.

Overview

The columella, the strip of tissue between the nostrils, receives little attention in rhinoplasty literature. This retrospective study assessed how well it was corrected and whether the surgical approach made a difference, using two published methods of grading the deformity.

Sections of note

Retrospective study of 65 rhinoplasty patients, divided by approach: 15 open and 50 endonasal.
Correction was assessed using the classification by Rohrich and Liu and Gunter's distance between the nasal axis and the columella.
Overall columellar correction: 90 percent in the endonasal group, 45 of 50, versus 67 percent in the open group, 10 of 15, P 0.043.
Reduction in the nasal axis to columella distance occurred in 49 of 50 endonasal patients, 98 percent, versus 12 of 15 open patients, 80 percent, P 0.036.
The quantitative reduction in that distance across all patients differed between groups with P below 0.001, favoring the endonasal approach.
The authors note this may relate to differences in the distribution of deformities between the two groups.
Their conclusion is that outcomes were comparable in achieving a satisfactory columella by either approach.

What it means for a patient

Both approaches corrected the columella in most patients.
The endonasal group performed better on the measurements, but the authors themselves attribute this partly to the two groups having different starting deformities.
The groups were very unequal, 50 versus 15, which limits the comparison.
Limits: retrospective, not randomized, and the abstract's conclusion of comparable outcomes sits uneasily with the reported significant differences.

Why this paper matters

The columella shapes the nostril appearance and is a frequent source of dissatisfaction, yet it is rarely the focus of outcome studies. Measuring it with defined classifications is a step toward that. The unequal non-randomized groups mean the approach comparison should not be relied on.

Terms

Columella: The strip of skin and cartilage between the nostrils.
Endonasal approach: Surgery done entirely through incisions inside the nostrils.
Open approach: Surgery using an added external incision across the columella.
Nasal axis: The midline running down the length of the nose.
Retrospective study: Analysis of records after the events occurred.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Unlabelled: The columella is an underrepresented part of rhinoplasty. The objective of this study was to assess the outcome of columella correction following rhinoplasty and to assess any differences in the open and endonasal approach.

Methods: This is a retrospective study involving 65 rhinoplasty patients, who were divided into 2 groups depending on whether they had an open or endonasal approach. Fifteen patients underwent the open procedure, and 50 patients underwent the endonasal approach. Patients who underwent endonasal rhinoplasty were compared with open rhinoplasty patients in terms of their final outcome, with a focus on the columellar correction. The classification by Rohrich and Liu and Gunter's distance between the nasal axis and columella were used to assess the correction.

Results: The overall incidence of columellar correction was 90% in the endonasal group (45 of 50 patients) and 67% in the open approach group (10 of 15 patients); a comparison shows a P value of 0.043 (<0.05). An estimated 49 of 50 patients (98%) from the endonasal group saw a reduction in the nasal axis-columella distance when compared with the open rhinoplasty group, who saw a reduction in 12 of 15 patients (80%); statistical analysis shows a P value of 0.036 (<0.05). The quantitative reduction in this distance in all patients when compared between the 2 groups had a P value of <0.001, suggesting a greater overall reduction using the endonasal approach. This may be related to differences in distribution of the deformities within the 2 groups.

Conclusions: There is no standard way to correct the columella, but it is important to identify the deformity and the need to correct it. In our patients, we found comparable outcomes in achieving a satisfactory columella in the open and endonasal groups.

Abstract as indexed by PubMed; the article is open access (PubMed Central).