Excessive showing of the Columella in relationship to the nostril width gives the appearance of a “hanging Columella”. A hanging Columella can either inherent or develop as a complication of rhinoplasty.
Retraction of the alar rim, as well as the excessive fullness of the end of the (caudal) septum will also give the hanging Columella look.
To reduce the Columella show during Revision Rhinoplasty a part of the caudal septum can be trimmed or the medial leg of the alar cartilage can be sutured back to the edge of the septal cartilage. This will pull back the Columella and will reduce its exposure.
An alar notch deformity which is the notching or the pull back of the alar edge (nostril’s edge) will also increase the Columella show and thus will give the Hanging Columella appearance. In these instances, the alar edge can be advance either with the use of injectable fillers or with an alar cartilage graft, otherwise known as the alar rim batten graft.