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2025.12.22
What is Nasal Columella Lowering Surgery?｜The Difference Between "Nasal Columella Lowering Surgery" and "Septal Extension"
As a board-certified plastic surgeon, I have handled numerous cases involving trauma, reconstruction, and congenital conditions, cultivating precise techniques and deep anatomical understanding. Driven by the desire to deliver the transformative power of beauty—where visible change uplifts the spirit—I pursued a career in cosmetic surgery. My areas of expertise include comprehensive eye treatments, injectable therapies, and anti-sagging procedures. Guided by a commitment to sincerely address each patient's aspirations, I provide meticulously crafted treatments focused on achieving beauty.
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Many people considering rhinoplasty find themselves confused by the difference between "columellar reduction" and "septal extension."
Since both procedures are often discussed as surgeries to refine the appearance of the tip of the nose, choosing one without understanding the differences can lead to feeling that "the results aren't what I expected."
The impression of the nose is not determined solely by the bridge or height,The balance between the front view and the profileis greatly influenced by.
Among these, the relative position of the nasal septum becomes crucial.ACRとnasolabial angleThis is an indicator.
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■ Nasal Bridge Lowering
Nasal bridge lowering, as the name suggests,Lower the position of the nasal septumby doing so,Improve the balance between the tip of the nose and the mouth areaThis is the way of thinking.
A short nasal bridge tends to emphasize the nostrils when viewed from the front, making the nose appear wider from the side.
When the nasal bridge is positioned appropriately, it creates balance between the nose and midface, giving the impression that the entire nose has been elongated vertically.
Even if the change is subtle, its impact on the overall impression of the face is by no means small.
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■ Balance of the Nose Viewed Head-On with ACR
When considering the balance of the nose from the front view, it is important to note that...ACR (Alar-Columellar Relationship)is.
Source: 'Cosmetic Surgery Techniques: Rhinoplasty, 1st Edition' (Kakuseido Publishing Co., Ltd., 2012) p.15,18 (Figures partially modified for publication)
ACR isThe relative positional relationship between the alar and the columellarefers to.
In an ideal ACR, when viewed from the front, the columella is positioned slightly below the line of the alar base,Inverted triangledraws.
When the nasal bridge is at the same height as or higher than the nostrils, the size and drooping of the nostrils become emphasized, creating an unbalanced appearance.
Lowering the nasal septum plays a role in improving the balance of the nose when viewed from the front by adjusting this ACR.
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■ Nasolabial Angle and Profile Balance
On the other hand, what is important when evaluating the balance of a profile isnasolabial angleis.
Source: 'Aesthetic Surgery Techniques: Rhinoplasty, 1st Edition' (Kakuseido Publishing Co., Ltd., 2012) p.18 (Figure partially modified for publication)
The nasolabial angle refers to the angle formed when connecting the base of the columella to the upper lip. The more appropriate this angle is (90–95°), the more harmonious the profile appears.
A short nasal bridge can result in a shallower angle, making the philtrum appear longer and emphasizing the mouth area.
By adjusting the nasal bridge downward, the nasolabial angle improves, naturally refining both the front and side profiles.
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■ Nasal Columella Lowering Surgery
Nasal columella reduction surgery is,Transplanting auricular cartilage to the nasal columellaThis is a procedure to lower the position of the nasal septum.
This procedure aims to harmonize the balance between the front and side profiles by adjusting the "appearance" and "relative positioning," rather than aggressively projecting the tip of the nose forward.
Since this procedure does not involve major structural reconstruction, the texture tends to remain relatively soft and the changes appear natural.
The key feature of this procedure is that it acts on both the ACR and the nasolabial angle.
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■ Relationship with Nasal Septum Extension
Septal extension is a surgical procedure that adds cartilage to the nasal septum—the structure supporting the bridge and tip of the nose—to reconstruct the nasal axis itself.
As a result of raising or pushing the nose forward,The bridge of the nose appears to slope downward.There are also cases。
Also,To achieve nasal columella lowering, the cartilage placement is carefully adjusted during septal extension.In some cases.
However, nasal septum extension is fundamentally a procedure to create structure, and its purpose and approach differ from columellar reduction.
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■ Differences Between Nasal Columella Lowering and Septal Extension
Nasal columella reduction is a "balancing procedure" that adjusts the position of the nasal columella to refine the ACR and nasolabial angle.
On the other hand, nasal septum extension is classified as a "structural procedure" that rebuilds the nasal framework.
It's not a matter of which is superior; their roles differ depending on the condition of the nose and the desired changes.
It is important to achieve harmony with minimal intervention, avoiding unnecessary structural alterations.
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■ Summary
When considering nasal columella reduction, it is essential to understand both the frontal balance achieved through ACR and the profile balance determined by the nasolabial angle.
Nasal columella reduction is one effective option for correcting these issues.
Rather than focusing solely on the tip of the nose, selecting a surgical technique based on an understanding of the overall position and structure of the nose leads to natural-looking rhinoplasty results with high patient satisfaction.
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【Profile】
Masataka Fujihashi, MD, Plastic Surgeon
Leveraging expertise as a board-certified plastic surgeon, I offer comprehensive facial cosmetic procedures including eyelid and nose surgery, facial liposuction, thread lifts, and hyaluronic acid injections. From incisional surgeries and revision procedures requiring delicate design to minimally invasive injections and lifts with minimal downtime, I strive to provide treatments tailored to each patient's ideal outcome.
We are dedicated to achieving natural results and minimizing downtime, pursuing medical care that leaves you feeling confident in your choice through sincere consultations.
Designing natural beauty with trust.
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【Career】
March 2015: Graduated from the School of Medicine, Showa University
April 2015 Showa University Yokohama Northern Hospital Initial Clinical Training
April 2017 Showa University Hospital Department of Plastic Surgery
October 2017 Maebashi Red Cross Hospital Plastic Surgery / Cosmetic Surgery
April 2019 Nishio Municipal Hospital Plastic Surgery Department
April 2020 Showa University Fujigaoka Hospital Plastic Surgery Department
November 2020 Ota Nishinouchi Hospital Plastic Surgery / Cosmetic Surgery
July 2022 Tokyo Rosai Hospital Plastic Surgery / Cosmetic Surgery Department Head
July 2022: R.O.clinic (Part-time), Kusano Taro Clinic (Part-time)
April 2024 Deputy Director, Ginza TA Clinic
November 2025 BIANCA CLINIC
【Professional Affiliations and Qualifications】
Japanese Society of Plastic and Reconstructive Surgery Board-Certified Plastic Surgeon
Member of the Japanese Society of Aesthetic Plastic Surgery (JSAPS)
Member of the Japanese Society of Aesthetic Surgery (JSAS)
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