Can A Deviated Columella Be Fixed By An External Approach?

Q: Dr. Eppley, I am writing to ask whether you might consider providing some guidance. I have had two rhinoplasty and one septoplasty over the last 1o years. They have not been successful in correcting the columella position to centre of face. I have read your case study External Repositioning of the Deviated Columella and Nostril when I was researching whether simply repositioning the soft tissue could be helpful as I believe it would. However my surgeon doesn’t seem to agree and will not consider another rhinoplasty, of which I don’t want to go through another anyway. Is there a professional medical opinion you could share with me to pass to her? I wonder whether the hesitation is simply because this isn’t a ‘standard’ approach. Thanks so much in advance 

A:Until I see pictures of the base of your nose I can only make a general statement about an external columella repositioning. Having done it numerous times it is effective and there is no reason it couldn’t be done. Everyone that I’ve ever done it on is in the exact same situation like yours. They been through multiple septorhinoplasties which have failed to align the columella centrally and in some patients it may never be possible by internal repositioning. In some cases the external columella realignment may be combined with the caudal septal graft to ensure it’s new position. I can certainly understand why most surgeons would have an opinion that this is an undoable procedure. But until a surgeon has tried it and failed such negative opinions are irrelevant.

The one issue that does have consideration is that it is likely your prior rhinoplasties were done with an open approach, meaning there is an existing mid-columellar scar. This does raise some concerns about a new incision at the columellar base which leaves a very narrow strip of skin for survival between those two scars (aka vascular compromise). So where are that mid columella incision is exactly could influence whether this is a viable procedure for you.

Dr. Barry Eppley

World-Renowned Plastic Surgeon