The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal tip and the alae are structured by the so called alar or lower lateral horseshoe shaped cartilages with their lateral and medial crura or crus and accessory cartilages, the domes between lateral and medial cruras, the interdomal fibrofatty pad, the caudal or lower septum and the skin of the alae.
Both halves of the nasal tip join with each other in the center of the tip to form a tripod in which the lateral legs are the lateral cruras of the alar or lower lateral cartilages and the central leg the union of both medial cruras of the alar or lower lateral cartilages.
The columella or central portion between the nostrils can be invisible or barely visible (normally only from 2 to 4 mm of septum mucosa should be seen) due to different causes which might coexist in one particular case; one very common cause of columellar invisibility is the alar protrusion (the side curtain covering the columella sets too low), however this is not a really retracted or sunken columella, just the alar rims are going too far low covering it; small alar or lower lateral cartilages medial cruras may cause a real sunken (not a retracted one) columella since these cruras lie just beneath the columellar skin; a short septum fails to support the medial cruras at the columella making it too little visible (neither retracted) as well; finally some post surgical cases may also suffer from really retracted columella due to fibrosis or poorly planned techniques at the caudal or lower septum and at the columella.
When the columella is too little visible for whatever reasons the infratip lobule is flat or even sunken, the septal mucosa is invisible and the nostrils are smaller than usual, with frequent association with bulbous tip and boxy tip, being the overall nasal look grotesque and artificial, leading to lack of suitable femininity in women and an unsightly look in men.
Treatment of columellar invisibility has to be customized to each individual situation; for protruding alar rims the main pillar are techniques of alar or lower lateral cartilages trimming, plasties and plications (shaping sutures through the cartilages); for thin medial cruras and post surgical cases the treatment is based on grafting such cartilaginous medial cruras and eventually apply caudal extension grafts, septal lengthening, columellar grafting, nasal tip grafting, with or without reinforcement of tip support with columellar strut.
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DR. ALEJANDRO NOGUEIRA'S SUNKEN COLUMELLA CASES PHOTO GALLERY
BEFORE & AFTER
INTRAOPERATIVE & TECHNICAL
See more accessing Dr. Alejandro Nogueira's entire Sunken columella Before & After gallery of cases.
See more accessing Dr. Alejandro Nogueira's entire Sunken columella Intraoperative & Technical gallery of cases.
REVIEWS & RATINGS
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- Medicine and Surgery are not exact sciences, therefore it is not possible to foretell the most likely evolution neither establish the most suitable management for each individual case until the moment the physicians can preoperatively evaluate the patient and receive feedback about the postoperative.
- One surgical process can't be fully predictable or be rigidly scheduled on a previous protocol, so the management plan may be modified at any time based on the requirements that could be considered as necessary or most suitable.
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- Every patient's individual satisfaction is somehow unpredictable, since this will depend on multiple particular, frequently unpredictable and sometimes uncontrollable expectation factors of a very much subjective, cultural, psychological and intellectual kind.
- Even when you feel very similar to another patient in their experience, your grade of satisfaction will likely vary significantly, because you are a unique person and every individual has not only a completely unique psyche, but also uniquely individualistic assessment capacities, expectation tendencies and acceptance processes, some of which are unpredictable even in very well mentally balanced patients who reflect adequately and do all the other right and recommended assessments before and after their procedure.
- All images are genuine, trustworthy and real standard views of the "before" situation and the long term settled "after" actual results of Dr. Alejandro Nogueira’s work, as well as true intraoperative surgical views and authentic technical or clinical scenarios depicting real practice hands-on cases belonging to Dr. Alejandro Nogueira's skills and expertise.
- No other professional but Dr. Alejandro Nogueira himself as leading and executing surgeon has carried out the techniques, procedures and surgeries shown in the galleries.
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- Every patient has to be assessed individually in order to establish a customized prognosis of results and design an individual surgical plan, being somehow unpredictable the real final outcome of any procedure as well the surgical gestures applied during the intervention, since they will depend on multiple particular, frequently unpredictable and sometimes uncontrollable factors.
- Even when you feel that you look very similar to another patient in their images, your results will likely vary significantly, because you are a unique person and every individual has not only a completely unique physique, but also uniquely individualistic body healing capacities, scarring tendencies and recovery processes, some of which are unpredictable even in very-healthy patients who rest adequately and do all the other right and prescribed things before and after their procedure.
- Previous successful results of a physician do not guarantee future successful procedures and patient's satisfaction.
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