Abstract
In author’s hands, columella sliding is a surgical technique to correct unaesthetic/unwanted depression or projection of the nasal tip. The tip can be increased or decreased by a simple mini-invasive technique during primary or secondary rhinoplasty as well as by a separate procedure. Main aim of the technique is to obtain the aesthetic 30° angle between dorsum and profile line and correct volume of the nasal tip at the line of the beauty triangle. It is possible to change the projection of the nasal tip using a retrocolumellar incision, to slide columella against septum upward or downward and fix the new position with 2–3 transmucosal columella-septal sutures. The stitches will be removed after 2–3 weeks, which is enough for columella to heal stable initially to septum. Columella sliding is an important technique to obtain a dorsoprofile angle of 30°, which is an aesthetic rule. The technique is atraumatic, mini-invasive, nearly bloodless. The procedure is very well tolerated by patients: there is no need of casts, tampons, and patients return to social life almost immediately.
Keywords
- Rhinoplasty
- columella sliding
- retrocolumellar incision
- columella-septal incision
- mattress transmucosal suture
- columella sliding upward
- columella sliding downward
- no downtime
- atraumatic
1. Introduction
1.1. Surgical procedure
Nasal tip projection determines how far out from the face the tip protrudes. The author accepts that the correct position of the nasal tip is in close relation to the 300 dorsoprofile or dorsoalar angle [1-5], where the alar line refers to a vertical line drawn through the point where the alar base attaches to the cheek and establishes the straight profile line. A 300 dorsoalar angle is accepted as aesthetic.
When a retrocolumellar incision is present, 2–3 mattress transmucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the nasal tip. (Figure 1). Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum. The sutures are removed after 2 weeks. This time is observed to be enough to form a stable fibrosis and give a permanent result. Patients have to prevent the nasal tip from trauma. The depressor septi nasi muscle is responsible for smiling deformity. Excision of the depressor nasi muscle or botox injections could help additionally in this regard. Patients are asked to reduce wide opening of the mouth and too much laughing, in order to prevent from depressing the tip during the early post-op and healing period.
The author has experienced no complication with any of the above-described transcutaneous and transmucosal sutures in more than a thousand operated cases. Sutures can be placed at any time as ambulatory procedures with no downtime.
2. Clinical cases
3. Conclusion
Columella sliding is a very useful mini-invasive technique to control position of the nasal tip as an independent procedure or as a part of primary or secondary rhinoplasties. It is simple, atraumatic, and very well accepted by patients. There are no known complications and the columella is fixed and heals in the new position in 2–3 weeks. There is no bruising, no need of tapes, tampons, or casts. Downtime is minimal and patients can return to social life almost immediately.
References
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