Soft-tissue composition of the columella and potential relevance in rhinoplasty

Background: The columella serves as the medial limb of the nasal tripod, with the medial crura functioning as the cartilaginous framework. Although softtissue of the columella may have both functional and aesthetic implications, it is a topic not often discussed in the rhinoplasty literature. The objective of this study was to evaluate soft-tissue histology of the columella and discuss findings that are pertinent to clinical rhinoplasty. Methods: Ten fresh cadaver heads were obtained from The University of Texas Southwestern Willed Body Program. En bloc resections of the columella were harvested. Specimens were fixed in formalin and embedded in paraffin. Subsequently, specimens were sectioned serially and stained. Staining with hematoxylin and eosin was performed to evaluate collagen and fat composition. Van Gieson elastin stain was completed to assess for elastin fibers. Results: Laterally, the columella was framed by stratified squamous epithelium, which transitioned to mucosa at the level of the membranous septum. An areolar tissue plane was found between the skin and adjacent medial crura. Much greater soft-tissue volume was present between the bilateral medial crura. Soft-tissue composition was found to be heterogenous, with varying distributions of tissue at different levels of the columella. Present in notable volume were fibroblasts, collagen fibers, elastin fibers, adipocytes, and neurovascular structures. Conclusions: Columella soft-tissue is remarkable for the presence of fibroblasts, collagen and elastin fibers, muscle fibers, and adipocytes. These findings may have significant implications regarding surgical maneuvers influencing tip projection, effects of aging on the nose, and columellar aesthetics and function.