Role of Membranous Septum in the Alar-Columellar Relationship: Strategies in Closed-Approach Rhinoplasty

Erdal AI, İsmail BK, Şibar S.

What this paper says

In 97 closed rhinoplasties in which the membranous septum was never excised, the 7 patients with a hanging columella were corrected by other manoeuvres and none had a hanging or retracted columella at 12 months.

Overview

A hanging columella shows too much of the strip between the nostrils on profile, and textbooks often recommend cutting out part of the membranous septum to fix it. The Turkish authors reviewed 97 patients treated by closed rhinoplasty in 2022 with routine tip work and no membranous septum excision, and checked standardised 12-month profile photographs for hanging or retracted columella.

Sections of note

97 patients, closed approach, January to December 2022.
Hanging columella present preoperatively in 7 patients.
No hanging or retracted columella observed postoperatively in any patient.
The paper proposes an algorithm for alar-columellar abnormalities.
Complete preservation of the membranous septum did not cause hanging columella.

What it means for a patient

A hanging columella can be fixed without removing tissue from the membranous septum, at least in suitable cases.
Keeping this tissue avoids a step that is irreversible and can over-correct into a retracted columella.
The series is small for this specific problem (7 patients) and judged on photographs.

Why this paper matters

It questions a routine excision and supports a preservation-style alternative in closed surgery. Limits: retrospective, single centre, 7 affected patients, photographic assessment only.

Terms

Alar-columellar relationship: how the nostril rim and the columella line up on profile; ideally 2-4 mm of columella shows.
Hanging columella: the columella sits too low, showing excess.
Retracted columella: the columella sits too high, hidden by the nostril rims.
Membranous septum: the soft tissue between the septal cartilage and the columella.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“A normal alar-columellar relationship is crucial for lower third finesse in rhinoplasty. Hanging columella is a common complaint in the alar-columellar relationship and membranous septum excision is frequently recommended for its correction. This paper focuses on the role of the membranous septum in achieving a normal…”

Excerpt; the full abstract is on PubMed.