The management of alar columellar disproportion in revision rhinoplasty.

An otherwise attractive nose can be diminished aesthetically if the relationship of the nostril border and ala to the columella is not refined and proportional. Compared with other aspects of rhinoplasty, there has been little attention devoted to the proper diagnosis and treatment of alar columellar disproportion. This article highlights the relevant anatomic components, defines the proper alar columellar relationship, systematically analyzes the different types of alar columellar dis proportion, and stresses the importance of identifying the causative factors in formulating the optimal treatment plan, with particular emphasis on applications to revision rhinoplasty.