Objectives: Understanding and correcting primary and post-rhinoplasty aberrations of the alar-columellar relationship (ACR).
Introduction: The alar-columellar relationship (ACR) describes the anatomical relation between the superior border of the alar margin and the caudal border of the columella. The visible space in-between these 2 anatomical elements is defined columellar show (CS). Multiple anatomical factors may affect size, orientation and contour of the CS. ACR aberrations represent one of the most frequent post-rhinoplasty stigmata.
Materials / method: Standard pre- and post-operative frontal, lateral and ¾ views of a series of 20 consecutive rhinoplasty patients presenting with excessive CS (11 primary rhinoplasty patients, 9 revision rhinoplasty patient) were analyzed in order to evaluate the aesthetical outcome of three surgical techniques, used singularly or in combination: personal variation of tongue-in-groove suture (TIG), rim grafts and post-crural grafts.
All the patient were operated endonasally (closed approach) under general anaesthesia. The mean follow-up was 21 months.
Results: Personal variation of TIG combined with tailor-made trimming of the membranous septum resulted highly effective in treating the central (septal) component of the excess of columellar show.
Regarding the lateral (alar) component of the excessive columellar show, alar rim grafts showed a poor performance in elongating the nostril border whereas post-crural grafts resulted to be more effective in down-positioning the nostril border.
After surgery, 3 patients (2 primary patients, 1 revision patients) underwent minor touch-procedures for further improvement in a period between 8 and 15 months.
Conclusion: A thorough understanding of the multiple variables that result in aberrations of the ACR is the essential pre-requisite for a proper planning of the most suitable treatment options.
Significant improvements of the alar columellar relationship can be predictably achieved by relatively minimally-invasive endonasal surgery procedures. However, in most of the cases the surgeon must correct the whole tip-columella-lip complex in order to get superior aesthetic results.
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