Columellar Retraction: The above picture shows a person with hanging ala | nostril rim overhanging the nostrils. She also has some retraction of her columella as well. In this situation, she has both elements going on. Again, if you look at the photos below. You can assess these elements by drawing a circle around the nostrils from the side view and draw a line that goes through the most anterior and posterior points. The nostril rim and columella should be 1-2 mm above and below this line respectively. As you reference the top pictures again, you can see that you have a little of both happening. The nostril rim is overhanging and the columella is deficient. In the before and after, you can see how we improved each of those situations. You can click here to see more Before and After Rhinoplasty Images
Before and After Image after Revision Rhinoplasty with Diced Ear Cartilage for Dorsal Bridge Reconstruction and Tip Reconstruction. This improved her columellar retraction as you can see more columella from the side view. The way we achieved this was through a caudal septal extension graft and tip grafting. We will explain more of the below.
Columellar Retraction Correction Rhinoplasty: One way to improve columellar retraction is by lengthening the caudal septum. This is most effectively done by using a caudal extension graft. The picture shown below illustrates where the caudal extension graft is placed in blue. It is attached to the septum and the shape and position of the caudal extension graft can help shape the tip dramatically. The graft gives you the extension and allows the columella to show more as seen in the photo above.
Tip Grafting to Increase the Columellar Show: Sometimes the caudal extension graft can only push down the tip complex so much and you may need a little extra length. This is where tip grafting can further increase the columellar showing from the side and the length of the nose in total. The picture below shows an example of a tip graft. The blue outline shows where the Total Tip Graft is located.