The true hanging columella: Simplified diagnosis and treatment using a modified direct approach

An imbalance between the alar rim and the columella border can be a disturb ing aesthetic deformity. Lf the cause is a pseudohanging columella, the the rapy should be directed to the alar rims. When the deformity is a true hang ing columella with unusually wide medial crural cartilages, balance can be rester-ed by excising a C-shaped crescent of cartilage from the cranial bor der of the medial crura of the alar cartilages in a direct approach. This c ondition was present in approximately 15 percent of the patients reviewed. The treatment of a true hanging columella adds a subtle beneficial enhancem ent to the results of a rhinoplasty. The authors describe a simplified diag nostic method and present their experience treating the true hanging colume lla using a modified "direct approach" through a closed endonasal rhinoplas ty.