Columella Reconstruction Using the Philtral Flap in Patients with Columellar Deformity in Revision Rhinoplasty

Bastaninejad S, Kanani B, Ferreira MG, Amali A, Sanaye Pasand Z.

PubMed 41731229 Publisher (DOI)Free full text (PMC)

What this paper says

In 14 revision patients with columellar defects, a full-thickness flap from the philtrum plus a rib cartilage framework significantly improved both breathing and appearance scores.

Overview

Loss of the columella (the strip of tissue between the nostrils) from trauma or earlier surgery is hard to repair because it needs both lining and support. The authors report a case series of 14 patients treated through an open approach: costal cartilage was harvested to rebuild the framework, and a vertical full-thickness flap including orbicularis oris muscle was raised from the philtrum and moved into the columella. Outcomes were measured with SCHNOS and photographic analysis.

Sections of note

14 patients with columellar defects, all revision cases.
SCHNOS respiratory index improved significantly (p < .001).
SCHNOS aesthetic index improved significantly (p < 0.001).
Photographs showed significant changes in philtral and columellar lengths, columellar show and Goode's ratio.
Level of Evidence IV.

What it means for a patient

A destroyed or badly retracted columella can be rebuilt using tissue from the upper lip, with rib cartilage for support.
In this small series patients breathed and looked measurably better afterwards.
The lip donor site is left with a vertical scar; the abstract does not report scar outcomes.

Why this paper matters

It documents a specific salvage technique for a rare but severe revision problem. Limits: 14 patients, no comparison group, follow-up not stated in the abstract.

Terms

Columella: the fleshy strip separating the nostrils at the base of the nose.
Philtrum: the vertical groove between the nose and upper lip.
Full-thickness flap: a piece of tissue including skin, muscle and lining moved with its blood supply intact.
Costal cartilage: cartilage taken from a rib.
Goode's ratio: tip projection divided by nasal length; an ideal is about 0.55-0.60.

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

Abstract

Background: Columellar defects, resulting from trauma or surgery, pose both functional and aesthetic challenges. This study evaluates the functional and aesthetic outcomes of columellar reconstruction using the philtral flap method in a case series of fourteen patients with columellar defects, focusing on respiratory and aesthetic outcomes.

Methods: Participants: Fourteen patients with columellar defects.

Procedure: Costal cartilage was harvested, and a philtral flap was designed with an open approach. Septal and nasal floor mucosae were elevated bilaterally, and a vertical incision was made on the philtrum. A full-thickness flap, including orbicularis oris muscle, was mobilized, and the nasal framework reconstructed with rib cartilage.

Evaluations: The SCHNOS questionnaire assessed functional outcomes, while photographic analysis evaluated aesthetic changes. Data were analyzed using SPSS version 24.

Results: Functional Outcome: Significant improvement in the respiratory index (p < .001). Aesthetic Outcome: Significant improvement in the nasal aesthetic index (p < 0.001). Photographic Analysis: Significant changes in philtral and columellar lengths, show, and Goode's ratio.

Conclusion: The philtral flap method provides promising functional and aesthetic outcomes, with further studies needed to confirm these findings.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).