The columella is the narrow strip of skin and tissue between the nostrils. When its blood supply fails after surgery, the tissue can die, a problem called columellar necrosis. It is a serious complication, and it is the reason surgeons ask you to report certain changes quickly.

Key takeaways

  • Columellar necrosis means skin and tissue loss in the strip between the nostrils, usually from a poor blood supply after surgery.
  • Infection, rough dissection, trauma and tension on the columellar closure are the causes named in a 2026 surgical review.
  • Surgeons ask patients to report color change, rising pain, open skin or a bad smell promptly instead of waiting for the next appointment.

What is columellar necrosis?

Columellar necrosis, also written columella necrosis, is the death of the tissue in the columella, the narrow strip of skin between the nostrils, after its blood supply fails during or after nose surgery.

What causes columellar necrosis?

A 2026 review by rhinoplasty surgeon Toriumi names the main causes: infection, improper dissection, trauma, and excessive tension on the columellar closure. In that review, avoiding tension at the closure is listed as a way to prevent necrosis, and techniques such as advancing the base of the columella or using a Silastic healing chamber are described as preventive.

Revision surgery is usually technically harder because scar tissue and altered anatomy complicate dissection. Our guide to revision rhinoplasty explains why. The open approach also uses a cut across the columella, which is one reason to ask about how your surgeon approaches the nose. Published sources give no reliable incidence figure for columellar necrosis.

Smoking is widely discussed as a risk for poor wound healing. The charity ASH summarizes evidence that people who quit about four weeks before surgery have fewer wound-related complications, and notes that the Royal College of Anaesthetists advises stopping for at least several weeks. How and when to stop before your own surgery is a question for your surgeon.

What are the warning signs?

Aftercare sheets vary, but the principle is the same everywhere: tell your surgical team promptly about anything unexpected rather than waiting. The changes surgeons commonly ask patients to report in the nose area include:

  • skin that turns pale, bluish, dusky or dark
  • pain that is getting worse instead of better
  • blisters, open skin or a wound that is not closing
  • a bad smell, discharge or fever

This list is a general reporting guide, not a way to diagnose yourself. Some swelling and bruising are expected after any rhinoplasty, and the NHS lists bleeding, infection and breathing difficulty among the known risks. If you cannot reach your surgeon, use local emergency services or a hospital.

How is it managed?

Management depends on how much tissue is affected, and a surgeon decides it case by case. Toriumi’s review describes reconstruction of columellar defects as complex. It may involve upper lip tissue, composite grafts or local and regional flaps, with cartilage grafts providing structural support for the long-term result. In his chart review of 34 cases, all reconstructions were reported successful, with two complications. That is one surgeon’s series, not a general success rate.

Is hyperbaric oxygen used?

Hyperbaric oxygen therapy means breathing oxygen in a pressurized chamber. In a second review, Toriumi describes it as very helpful in complex rhinoplasty defects, especially with compromised blood supply, flaps or composite grafts, and prior infection. This is an expert’s experience, and the abstract does not report a controlled trial. Whether it is offered, when, and where depends on the surgeon and the local hospital, so ask.

What about drugs people mention online?

You may read about medicines, including ones used off-label for blood flow. They are not covered here. Whether any medicine is appropriate is for the treating team, who know your health history.

Questions to ask your surgeon

  • What is your approach to protecting blood supply in my type of surgery, especially if it is a revision?
  • Which signs should I report, and how do I reach you or your team at night or on weekends?
  • Is there a hospital with emergency capability connected to where you operate?
  • If a complication happened, would you manage it yourself, and who would pay for extra care?
  • Do you have experience with complication management, including referral for hyperbaric oxygen if needed?
  • If I live abroad, who do I see at home, and what do you need from them?

If you are traveling for surgery, the NHS notes that overseas clinics may not provide follow-up to the same standard, travel insurance does not normally cover problems after surgery, and you should plan how you would get home in an emergency. Our cost guide lists what a package should state in writing, and the safety guide for Turkey covers how to check a provider. To compare surgeons, see how to check a rhinoplasty surgeon.

Sources

All pages were opened and checked in October 2026.