Deviations of the nose are common and can involve any of its osteocartilaginous structures. One such deviated component is that of the columella, the strip of skin at the bottom of the nose that separates the two nostrils. It overlies the end of the cartilaginous septum which separates the two sides of the internal nasal airway. When looking from below its most obvious feature is its position between the nostrils, ideally being directly in the midline.
When the columella is deviated the most common reason is that the cartilaginous septum behind it is the cause. Caudal septal deviations are common and generally are indicative of a more complete septal deviation throughout its internal nasal course. Septoplasty and/or open rhinoplasty using various straightening techniques is the typical corrective surgery.
But when septal straightening does not work a more direct approach by external skin realignment can provide a definitive correction. This is done by making an incision along the nasal base-upper lip junction, similar to that if the sub nasal lip lift but not extended to the nostril base on the side away from the deviation. (red line) The columella and the wider nostril base are then moved into a midline position of the columella and medial movement of the nostril by skin excisions. (green lines)
This external repositioning of the columella and nostril can be an effective approach when more traditional rhinoplasty techniques have failed to do so.
Dr. Barry Eppley
World-Renowned Plastic Surgeon