Strategic Use of the V-Shaped Columella-Labial Incision for Reconstructive Rhinoplasty in Severely Compromised Noses

Sazgar AA, Sazgar MA, Zarei R, Sazgar AK.

What this paper says

In 91 patients with previous failed rhinoplasties and mid-columellar scars, a V-shaped incision at the columella-lip junction caused no wound breakdown or skin necrosis and cut SCHNOS obstruction scores from 52.9 to 18.4 and cosmesis scores from 78.1 to 20.2.

Overview

Re-opening a nose through an old columellar scar risks the skin flap dying. The authors placed the incision lower, as a V at the columella-labial junction, in open reconstructive septorhinoplasty for multiply operated noses, and recorded demographics, operative details, complications and SCHNOS scores before and one year after.

Sections of note

91 patients, 75% women, mean age 37.6, mean 1.74 previous rhinoplasties.
Mean operating time 239.5 minutes.
Grafts used: ear cartilage in 64, rib in 43, temporal fascia in 12, rectus fascia in 24.
No dehiscence or vascular complications, even with multiple prior mid-columellar incisions.
SCHNOS-O 52.86 to 18.43; SCHNOS-C 78.09 to 20.19.

What it means for a patient

A nose that has been opened before can be opened again safely by choosing a different incision line.
The V-Y closure also lengthens a short columella, a common problem in over-operated noses.
Surgery in these cases takes about four hours and uses multiple graft sources.

Why this paper matters

It is the companion series to the authors' prospective incision comparison and documents safety in the worst-case skin. Limits: retrospective, single centre, no comparison group in this paper.

Terms

Columella-labial incision: an incision where the columella meets the upper lip.
Dehiscence: a wound coming apart.
Vascular compromise: loss of blood supply to a skin flap.
Temporal fascia: a tissue sheet from the side of the scalp used as a soft graft.
SCHNOS: a validated nasal outcome questionnaire, 0-100, lower is better.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Columellar incision techniques for multiply operated and/or severely compromised noses are critical in reconstructive rhinoplasty, because they impact both the final outcome and the risk of complications, such as wound dehiscence and skin flap necrosis. Objectives: The aims of the study are to evaluate the safety of…”

Excerpt; the full abstract is on PubMed.