Components of the Hanging Columella: Strategies for Refinement.

The columella is a significant factor in the aesthetic balance of the nose, particularly the lower one-third of the nose. Its position is dependent on the anatomical constituents of the columella, and neighboring anatomical structures. Six components of the hanging columella have been identified: the caudal septum, medial crura, columellar skin, membranous septum, anterior nasal spine, and depressor septi nasi muscle. Columellar refinement begins with a careful analysis and diagnosis of the contributing components, followed by surgical techniques to address these components individually. The cumulative effect of correction of individual components appropriately positions the columella and contributes significantly to the enhancement of nasal aesthetics. Refinement of the columella can be achieved through appropriately trimming the caudal septum; repositioning and reshaping the medial crura; excising redundant columellar skin, membranous septum, and nasal mucosa; appropriately contouring the anterior nasal spine; and dividing the depressor nasi septi nasi.