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Facial Plast Surg 2025; 41(03): 347-351
DOI: 10.1055/a-2338-0701
Original Research

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

Ayhan Işık Erdal 
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
,
Bilge Kaan İsmail 
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
,
Serhat Şibar 
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
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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 alar–columellar relationship. It was aimed to present an algorithm that could be used for aberrancies in the alar–columellar relationship.

Ninety-seven patients who underwent closed-approach rhinoplasty between January and December 2022 were included in this retrospective study. Routine tip plasty maneuvers were performed on all patients. Membrane septum excision was not performed in any of the cases. Standardized preoperative and postoperative 12-month lateral view photographs were scanned for hanging or retracted columella.

Hanging columella was observed in seven patients preoperatively (n = 97). No hanging or retracted columella was observed postoperatively.

Hanging columella can be successfully corrected with alternative surgical maneuvers without excision of the membranous septum in closed-approach rhinoplasty in appropriate cases. Complete preservation of the membranous septum does not cause hanging columella in the postoperative period.

Keywords

rhinoplasty - membranous septum - alar–columellar relationship - hanging columella - retracted columella

Informed Consent

All participants were informed that their photographs could be published for scientific purposes and provided their written informed consent.


Ethical Approval

Ethics committee approval was received for the study from the Gazi University Ethics Commission (2024-32).




Publication History

Accepted Manuscript online:
04 June 2024

Article published online:
21 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gunter JP, Rohrich RJ, Kurkjian TJ, Ahmad J. Importance of the alar-columellar relationship. In: Rohrich RJ, Adams WP, Ahmad J, Gunter JP. eds. Dallas Rhinoplasty: Nasal Surgery by the Masters. 3rd ed. Quality Medical;; 2014: 557-566
    Search in Google Scholar
  • 2 Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 1996; 97 (03) 643-648
    CrossrefPubMedSearch in Google Scholar
  • 3 Rohrich RJ, Afrooz PN. Revisiting the alar-columellar relationship: classification and correction. Plast Reconstr Surg 2019; 144 (02) 340-346
    CrossrefPubMedSearch in Google Scholar
  • 4 Rohrich RJ, Afrooz PN. Components of the hanging columella: strategies for refinement. Plast Reconstr Surg 2018; 141 (01) 46e-54e
    CrossrefPubMedSearch in Google Scholar
  • 5 Randall P. The direct approach to the “hanging columella”. Plast Reconstr Surg 1974; 53 (05) 544-547
    PubMedSearch in Google Scholar
  • 6 Armstrong DP. Aggressive management of the hanging columella. Plast Reconstr Surg 1980; 65 (04) 513-516
    CrossrefPubMedSearch in Google Scholar
  • 7 Matarasso A, Greer SE, Longaker MT. The true hanging columella: simplified diagnosis and treatment using a modified direct approach. Plast Reconstr Surg 2000; 106 (02) 469-474
    CrossrefPubMedSearch in Google Scholar
  • 8 Pınarbaşlı MÖ, Çaklı H, Rhee CS. Surgical Management of the Nasal Septum. In: Cingi N, Bayar Muluk N. eds. All Around the Nose: Basic Science, Diseases and Surgical Management. Springer Nature Switzerland AG; 2020
    Search in Google Scholar
  • 9 Daniel RK, Pálházi P. An Anatomical and Clinical Atlas. 1st ed. Springer Cham;; 2018
    Search in Google Scholar
  • 10 Converse JM. The cartilaginous structures of the nose. Ann Otol Rhinol Laryngol 1955; 64 (01) 220-229
    CrossrefPubMedSearch in Google Scholar
  • 11 Stovin JS. The importance of the membranous nasal septum. AMA Arch Otolaryngol 1958; 67 (05) 540-541
    CrossrefPubMedSearch in Google Scholar
  • 12 Guyuron B. The aging nose. Dermatol Clin 1997; 15 (04) 659-664
    CrossrefPubMedSearch in Google Scholar
  • 13 Sajjadian A, Guyuron B. An algorithm for treatment of the drooping nose. Aesthet Surg J 2009; 29 (03) 199-206
    CrossrefPubMedSearch in Google Scholar
  • 14 Erdal AI, Genç İG, Pasinlioğlu B, Findikçioğlu K. Flexible tongue-in-groove technique and its effectiveness compared to classic tongue-in-groove and columellar strut graft techniques: a retrospective analysis of 237 open rhinoplasty cases. Plast Reconstr Surg 2021; 148 (06) 1221-1232
    CrossrefPubMedSearch in Google Scholar
  • 15 Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Oper Tech Otolaryngol Head Neck Surg 1995; 6 (04) 311-318
    CrossrefPubMedSearch in Google Scholar
  • 16 Totonchi A, Guyuron B. Alar rim deformities. Clin Plast Surg 2016; 43 (01) 127-134
    CrossrefPubMedSearch in Google Scholar