The strip of skin and tissue running between your two nostrils is called the columella, or more formally the columella nasi. The word comes from Latin, meaning “little column,” which fits its appearance: a narrow pillar of skin, cartilage, and soft tissue that divides the nostrils and connects the nasal tip to the upper lip. Though small and easy to overlook, the columella plays a surprisingly large role in how the nose looks, breathes, and ages, and it is one of the most carefully considered structures in nasal surgery.
What the Columella Is Made Of
The columella is not just skin. It is a layered structure. On the outside, you see skin that is thinner than most of the nose’s surface. Underneath that skin sit the medial crura of the lower lateral cartilages, two cartilage struts that run side by side and give the columella its shape and some of its rigidity. Between and around those cartilages is a thin layer of connective tissue. Deeper still, toward the inside of the nose, the columella blends into the membranous septum, a flexible, cartilage-free portion of the nasal septum that connects the columella to the firmer cartilaginous septum farther back. This membranous septum is what allows the columella a small degree of movement when you press or wiggle the tip of your nose.
Because the columella sits at the junction of so many structures, its appearance depends on all of them working together. The cartilage underneath determines how projected or flat the nasal tip looks. The skin’s thickness and elasticity affect how refined or bulbous the area appears. And the relationship between the columella’s lower edge and the nostril rims, visible when you look at someone’s profile, is one of the classic measurements surgeons use to assess nasal proportions.
Blood Supply and Sensation
The columella gets its blood primarily from the columellar arteries, which branch off the superior labial artery. The superior labial artery itself is a branch of the facial artery and arises near the corner of the mouth, making it the main blood supply to the upper lip as well.1Cureus. An Oblique Columellar Artery Variant This blood supply is reliable enough that surgeons can design skin flaps that keep the columella alive during complex reconstructive procedures, but anatomical variants do exist. Some people have columellar arteries that take unusual paths, which is relevant information for any surgeon making incisions in the area.
Sensation in the columella and nasal tip comes largely from the external nasal nerve, which travels between the nasal bone and the upper lateral cartilage before reaching the skin. This nerve path makes it vulnerable during surgery. Research on open rhinoplasty patients found that altered sensation in the nasal tip and upper columella occurs reliably about three weeks after surgery, because the subcutaneous dissection injures the external nasal nerve as it passes through that tight space.2PubMed Central. Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal Sensation typically returns over time, but the temporary numbness is something rhinoplasty patients should expect.
Why Surgeons Care So Much About the Columella
If you have ever looked into rhinoplasty, you have probably encountered the term “open rhinoplasty.” The defining feature of this approach is the transcolumellar incision, a small cut made across the columella that allows the surgeon to lift the nasal skin and see the cartilage framework directly. The alternative, closed rhinoplasty, hides all incisions inside the nostrils but gives the surgeon less visibility. The trade-off with the open approach is that the transcolumellar incision can leave a visible scar on the columella, right where anyone looking up at your nose might see it.
The good news is that with careful technique, these scars heal well enough to be nearly invisible. A favored incision placement is a low inverted-V shape just above the junction where the columella meets the upper lip, which heals with precise alignment and minimal visibility. Techniques using buried absorbable sutures to reduce skin tension during healing further improve the final appearance.3PubMed. Transcollumelar Incision and Closure Still, factors like skin type, sun exposure during healing, and individual scarring tendencies all influence the outcome.
Beyond the incision itself, the columella is structurally important in rhinoplasty because it houses the cartilage that supports the nasal tip. Surgeons frequently place a columellar strut graft, a small piece of cartilage positioned between the medial crura, to reinforce or reshape tip support. A comparative review of long-term outcomes found that while columellar strut grafts do contribute to nasal projection, they are not always essential for that purpose and should be used selectively.4PubMed Central. New Insights into the Role of Columellar Strut and Septal Extension Graft: A Comparative Review of Long-Term Outcomes A septal extension graft, which anchors to the septum rather than floating between the crura, tends to provide more stable long-term tip positioning. Some newer approaches, like the septocolumellar strut technique, aim to combine the benefits of both, and studies of that method have shown that tip projection remains stable between three and twelve months after surgery with essentially zero median change.5JPRAS Open. Septocolumellar strut technique: Tip stability and aesthetic outcomes in rhinoplasty
For patients with thicker skin or weaker native cartilage, particularly common in certain ethnic backgrounds and in revision cases, a wider-based columellar strut graft can provide a more robust structural foundation. This technique is especially useful for people with a retracted septum or a weak anterior nasal spine, where standard grafts may not offer enough support for lasting projection and rotation.6PubMed. Wide-Based Columellar Strut Graft: A Novel Boost for Enhanced Nasal Tip Support in Ethnic and Revision Rhinoplasty
The Columella and Cleft Lip
One of the most significant clinical contexts for the columella is cleft lip and palate, particularly the bilateral form. In bilateral cleft lip, the columella is often severely shortened or virtually absent, because the tissue that normally migrates to form this structure during fetal development is displaced. This gives the nose a characteristically flat appearance with a wide, underprojected tip.
Columella elongation is a key goal in surgical repair. Early techniques often left the columella still noticeably short, but more modern approaches have dramatically improved results. The Cutting-Grayson technique, which uses presurgical nasoalveolar molding to gradually stretch columellar tissue before the lip repair, has been shown to greatly improve columella length, nasal tip angle, and protrusion compared with older protocols, bringing measurements close to normal.7PubMed. Photometric evaluation of bilateral cleft lip and palate patients after primary columella lengthening Even with these advances, studies consistently find that nasal tip projection and columella length remain somewhat decreased in bilateral cleft patients compared with unaffected controls, and follow-up surgery to further improve nasal aesthetics is common.8PubMed Central. Columella Elongation Surgery Outcome in Complete Bilateral Cleft Lip and Palate
How the Columella Changes with Age
The nose does not stop changing when you finish growing. As the face ages, the support mechanisms that hold the nasal tip in place gradually weaken. Cartilage loses resilience, ligaments stretch, and the skin overlying the nose becomes thinner. The result is a set of changes that plastic surgeons describe as tip ptosis (the tip droops) and a hanging columella, where the columella’s lower edge drops below the nostril rims when viewed from the side.9PubMed. Restoring Balance and Symmetry to the Aging Nose Bone quality in the nose also becomes more brittle with age, which complicates any surgical correction.
A hanging columella can also occur in younger people due to their natural anatomy, not just aging. When too much columellar tissue is visible below the nostril rim on profile view, it can make the nose look disproportionate regardless of the person’s age. Conversely, a retracted columella, where too little shows, can create the appearance of a short nose or overly visible nostrils. Surgeons evaluate this relationship carefully during rhinoplasty planning, since correcting one aspect of nasal proportion without addressing the columella’s position can leave the overall result looking unbalanced.
Columellar Tumors
Skin cancers on the columella are rare, but they deserve attention because this location presents unique challenges. The columella’s small size means that even a tiny tumor can involve critical underlying structures, and the cosmetic consequences of removing tissue there are significant.
A case series of columellar tumors treated with Mohs micrographic surgery, a technique that maps tumor margins layer by layer, found that these tumors can behave aggressively despite their small initial appearance. Among eleven patients with nonmelanoma columellar lesions, all were excised to clear margins. Seven of eight basal cell carcinoma cases remained tumor-free for more than five years, and the squamous cell carcinoma cases also fared well with no local recurrence or distant spread.10PubMed. Tumors of the nasal columella treated by Mohs micrographic surgery A separate review of recurrent columellar carcinomas found a broader histological mix, including basal cell, squamous cell, mixed types, melanoma, and anaplastic carcinoma, underscoring the importance of biopsy and histological diagnosis for any persistent or unusual lesion in the area.11PubMed. Surgical rescue of recurrent carcinoma of the nasal columella
Reconstruction after tumor removal from the columella is particularly tricky because of the area’s three-dimensional structure and visibility. Options include local flaps from the cheek or perialar region, but the choices are limited. A successful single-stage reconstruction using bilateral cheek advancement flaps combined with perialar skin flaps has been described for cases where the columella, membranous septum, nasal base, and upper lip all needed rebuilding simultaneously.12British Journal of Plastic Surgery. Reconstruction of columella, membranous septum, and upper lip in a single stage operation The complexity of such repairs reflects just how structurally and aesthetically central this small piece of anatomy is.
Columella Piercings
The columella is the site of one of the most common nose piercings: the septum piercing. Despite the name, a properly placed septum piercing does not actually go through the cartilaginous septum. It passes through the membranous portion at the base of the columella, sometimes called the “sweet spot,” where the tissue is thin and flexible enough for the needle to pass with relatively little pain. When placed correctly, the piercing sits just in front of the cartilage, in the gap between the lower edge of the septal cartilage and the columella’s skin.
Incorrect placement, too far back through actual cartilage, is more painful, slower to heal, and more prone to complications. The columella’s blood supply from the superior labial artery generally supports good healing for a well-placed piercing, but the area’s exposure to nasal secretions and frequent touching means infection risk is real if aftercare is neglected. Healing time typically runs six to eight weeks for the initial closure, with full maturation taking several months longer.
Nasal Proportions Across Populations
The columella’s dimensions vary substantially across ethnic groups. Its length, width, and angle relative to the upper lip all contribute to what different populations consider an attractive nose, and those preferences are far from universal. A cross-cultural analysis of nasal aesthetics surveying both plastic surgeons and the general public found significant regional differences: respondents from Latin America and the Caribbean, for example, overall preferred smaller and narrower noses with more projecting tips, lips, and chins compared with respondents from other regions.13PubMed. Nasal aesthetics: a cross-cultural analysis
These preferences have direct implications for how surgeons approach the columella. In populations where a shorter, wider columella is typical, surgical goals differ from those in populations where a longer, narrower columella is the norm. Applying a single aesthetic standard across all patients has been one of rhinoplasty’s historical blind spots, and the field has increasingly moved toward ethnically sensitive approaches that respect baseline anatomy rather than imposing a one-size-fits-all ideal.
Skin Properties of the Columella and Nasal Region
When surgeons need to reconstruct the columella or other parts of the nose, they often borrow skin from elsewhere on the body. Choosing the right donor site matters because the mechanical properties of skin vary dramatically from one location to another. A study comparing skin elasticity across common donor and recipient sites found that forehead skin had the lowest elastic stiffness of all regions tested, while submandibular skin was the stiffest. Postauricular (behind-the-ear) skin fell in between.14PubMed Central. Comparison of the mechanical properties of different skin sites for auricular and nasal reconstruction
For columellar reconstruction, the ideal donor skin should be thin, pliable, and a good color match. Forehead and postauricular skin are commonly used because they tend to meet these criteria better than thicker, stiffer skin from areas like the jawline or forearm. Skin that is too stiff for the columella’s natural flexibility can create a rigid-looking result, while skin that is too lax may not hold shape well over time. The fact that the columella is visible from multiple angles, below when someone looks up at you, from the side in profile, and from the front, means the reconstructed skin has to blend seamlessly in three dimensions.
Airflow and the Base of the Nose
The columella forms the medial wall of the nostrils, so its shape contributes to how air enters the nose. However, research into nasal airflow dynamics suggests that the columella’s contribution to airflow resistance is modest compared with structures deeper inside the nasal cavity. A study using physical nose models found that the relative projection of the inferior turbinate, a structure well inside the nose, was the only variable that significantly affected the flow rate at which airflow became turbulent. Nostril orientation showed a moderate but statistically insignificant correlation with flow dynamics, while the nasal valve area and nasal sill height were unrelated to turbulence.15American Journal of Human Biology. Morphological variation and airflow dynamics in the human nose
That said, the columella still plays an indirect role. A severely deviated columella can narrow one nostril relative to the other, and a retracted or hanging columella can alter the effective opening of the nasal vestibule. People who have had columellar surgery sometimes report temporary changes in airflow perception during healing, as swelling and tissue remodeling transiently alter the geometry of the nostril openings. Once healed, a well-planned surgical columella that restores normal proportions should not impair breathing and can even improve it if the preoperative anatomy was obstructive.