Triangular Medial Crus Excision: A Novel Technique for Correction of Excessive Columellar Show

Objective: To describe mid-medial crus triangular excision for excessive columellar show and evaluate patient satisfaction and Blinded Expert-rated photographic improvement at 1 year.Methods: This retrospective case series included 47 adults who underwent primary closed rhinoplasty with bilateral mid-medial crus triangular excision. We categorized preoperative alar-columellar morphology separately for each side using the Gunter classification. Bilateral alar rim grafts were used in nine patients. We assessed outcomes using preoperative and 1-year postoperative Rhinoplasty Outcome Evaluation (ROE) scores on a 0–100 scale and independent right- and left-sided photographic ratings by two Blinded Experts using a study-specific 5-point improvement scale.Results: The mean age was 30.49 ± 7.22 years, and 33 patients (70.2%) were women. Thirty-eight patients (80.9%) had type I and nine (19.1%) had type III morphology bilaterally. The mean ROE score increased from 35.99 ± 9.88 to 84.04 ± 7.54, with a mean increase of 48.05 ± 13.84 points (p < 0.001). Both Blinded Experts assigned scores of 4 or 5 to every assessed side. The proportion of score-5 ratings ranged from 80.9% to 85.1% across the four Blinded Expert-by-side assessments.Conclusion: The surgical approach was associated with increased patient satisfaction and favorable Blinded Expert assessments of columellar appearance at 1 year. Comparative studies with calibrated measurements are needed to establish the specific contribution of triangular excision.