Q: Dr. Eppley, My rhinoplasty is tricky as my stiff columella is my main complaint. wonder if the actual columella bone can be shaved without addressing the tip of the nose. I have read about anterior nasal spine reduction but I am not sure what that is. I am open to suggestion.
A: The reason that your columella is so stiff is that you have a prominent anterior nasal spine. This is what you refer to as the ‘columellar bone’. The end of the nasal septum, which sits behind the columella of the nose, rests on the anterior nasal spine. The longer and more prominent the anterior nasal spine is on the maxillary bone, the more forward will sit the end of the septum. This causes a very open nasolabial angle (angle between the base of the nose and the upper lip which inn most men should be about 90 to 95 degrees) and a very firm and stiff feeling columella. The anterior nasal spine reduction procedure removes the bony prominence and the base of the end of the cartilaginois septum that attaches to it will allow the nasolabial angle to sit back, decreasing the tension on the columella and the upper lip. This can be done by itself or one of the many maneuvers in an overall rhinoplasty procedure.
Dr. Barry Eppley