Q: I am an Asian male and I have a retracted columella and a slightly acute nasolabial angle (I’d estimate it to be roughly 85 degrees). I have read that it is possible to use cartilage (either from the septum or the ear) and fill in the area of the columella to increase the nasolabial angle. I have also done research and found that a subnasal lip lift can correct the nasolabial angle as well. I don’t want anything else done but to have the base of the columella fixed. How do you recommend it to be done?
A: Correction of the too acute nasolabial angle can be done by directly addressing the source of the problem. The nasolabial angle is effected by numerous anatomic factors but the angulation of the causal end of the septum and the anterior nasal spine most directly influence it. I am not aware that a subnasal lip lift can change the nasolabial angle to any great degree and that would not be an option unless one had a long upper lip concern also. Correction should be directed towards modifying the underlying osteocartilaginous foundation. Cartilage grafts can be used to buildup the base of the caudal septum. But attaching grafts in an end-to-end manner to the end of the septum has them being unstable and to wiggle back and forth. To be stable they have to be placed as a bilayer with the septum in the middle of the ‘sandwich’. A more stable method is to augment the anterior nasal spine, also known as premaxillary augmentation. Cartilage grafts and synthetic implants can be used but I find that a dermal graft is the best graft in the long-term for this area. That can be placed through an intraoral incision under the upper lip above the frenum.
Dr. Barry Eppley