CORRECTION OF ASYMMETRIC NOSTRILS (ALAE) BY COLUMELLA TRANSPOSITION

Nasal alar reconstruction is one of the most difficult technical maneuvers in all of plastic surgery. Various methods of lower nasal and columellar reconstruction have been described, including composite grafts, forehead flaps, nasolabial flaps, alar flaps, and others.1-6 A frequent sequela of lower alar reconstruction is a deficient or contracted ala resulting in nostrils of disparate size, shape, or orientation. This asymmetry has been addressed with a variety of reconstructive approaches, including augmenting the deficient ala or reducing the larger ala.7 We have used a “divide and conquer” method with columellar transposition that obviates introduction of new tissue or the excision of “excess” tissue to achieve nostril symmetry. Taking both nostrils as the “whole” with the normal columella dividing the larger and smaller nostrils, we transpose either the foot or the head of the columella toward the side of the larger nostril and correct the asymmetry. © 1994 American Society of Plastic Surgeons.