Purpose: Descriptions of the columellar lobular complex focus on measurements of the aesthetic columellar lobular angle, which is reported to be 45 degrees, ignoring other characteristics of an aesthetically desirable columellar lobular complex. (1) The purpose of this report is to define what constitutes an aesthetic columellar lobular complex and describe the appropriate surgical intervention to correct abnormalities. 

Methods: Pre and postoperative lateral photographs of 75 rhinoplasty patients were reviewed.  Forty-three of the photographs were judged to have aesthetically pleasing columellar lobular complexes. For those judged to be aesthetically pleasing the following measurements were made: 1. Columellar lobular angle 2. Anterior-posterior (A-P) position of the columellar lobular angle in relation to the anterior end of the normally positioned nostril. Using the range of each of these measurements as acceptable aesthetic goals, the pre and postoperative photographs were again reviewed to identify common abnormalities.

Results:  Measurements of the aesthetic columellar lobular angle ranged between 20 and 45 degrees.  The aesthetic A-P position of the columellar lobular angle ranged between 1 mm posterior and 2 mm anterior to the anterior end of the normally positioned nostril.  Further analysis revealed the aesthetically pleasing range of columellar lobular angle measurements varied depending on the A-P position of the angle.  If the columellar lobular angle was between 1 mm posterior and 2 mm anterior to the anterior end of the nostril, then the range of 20 to 45 degrees was aesthetically acceptable.  However if the columellar lobular angle was greater than 1 mm posterior to the anterior margin of the nostril, the aesthetic range for the columellar lobular angle decreased to 15 to 35 degrees.  In this instance a columellar lobular angle of 45 degrees produces a short nose and an unaesthetic columellar lobular complex. (Fig 1, preoperative)  If the columellar lobular angle is greater than 2 mm anterior to the nostril the columellar lobular angle is ill defined and difficult to measure.  Aesthetically the nasal tip lacks definition.  (Fig. 2, preoperative) 

Conclusion: Defining the aesthetic columellar lobular angle as 45 degrees belies the complexity of the columellar lobular complex. Aesthetic columellar lobular angle measurements vary depending on the A-P position of the angle.   If the surgeon determines that repositioning the columellar lobular angle in the A-P dimension and/or changing the degree the angle will improve the aesthetic outcome, an open rhinoplasty should be considered.  Using this approach the medial and intermediate crura are scored on the cephalic or caudal margins depending on whether the angle is to be decreased or increased respectively.  The crura are then suture stabilized to a columellar strut to correct the A-P position and the angular measurement. Figures 1 and 2 demonstrate the improved aesthetic outcome possible when the rhinoplasty surgeon understands the aesthetic relationship between the A-P position and the angular measurements of the columellar lobular angle.