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Revisiting the Alar-Columellar Relationship: Classification and Correction

Rohrich, Rod J. M.D.; Afrooz, Paul N. M.D.

Plastic and Reconstructive Surgery: August 2019 - Volume 144 - Issue 2 - p 340-346
doi: 10.1097/PRS.0000000000005835
Cosmetic: Special Topic

Summary: The alar-columellar relationship has tremendous aesthetic significance in the lower one-third of the nose. Aberrancies in the alar-columellar relationship detract from nasal aesthetics, and are classified into six types: type I, hanging columella; type II, retracted ala; type III, combination of a hanging columella and retracted ala; type IV, hanging ala; type V, retracted columella, and type VI, combination of a hanging ala and retracted columella. This article describes the methods for proper evaluation and diagnosis of aberrancies in the alar-columellar relationship, and current strategies to restore the ideal alar-columellar relationship.


Dallas, Texas; and Miami, Fla.

From the Dallas Plastic Surgery Institute; and the Institute of Aesthetic Medicine.

Received for publication January 14, 2018; accepted August 22, 2018.

Disclosure:Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing; is a clinical and research study expert for Allergan, Inc., Galderma, and MTF Biologics; and is the owner of Medical Seminars of Texas, LLC. Dr. Afrooz has no financial interest to declare in relation to the content of this article. No funding was received for this article.

Rod J. Rohrich, M.D., Dallas Plastic Surgery Institute, 9101 North Central Expressway, Suite 600, Dallas, Texas 75231,, Facebook: Rod J. Rohrich / @DrRodRohrich, Twitter: @DrRodRohrich, Instagram: @Rod.Rohrich

Copyright © 2019 by the American Society of Plastic Surgeons