A Prospective Comparison of Inverted V Mid-columellar and V-Shaped Columellar-Labial Incisions in Reconstructive Rhinoplasty

Sazgar AA, Aalizade A, Zeyfoalzam M, Golparvaran S, Sazgar MA.

PubMed 41998166 Publisher (DOI)Free full text (PMC)

What this paper says

In 52 severely deformed noses, a V-shaped incision at the columella-lip junction closed as V-Y gave more tip projection and columellar height at one year than the standard mid-columellar incision, with equal scar quality.

Overview

Reconstructive rhinoplasty for badly damaged noses usually reuses the mid-columellar incision. The authors prospectively compared that incision (Group B, n = 26) with a V-shaped columella-labial incision closed V-Y (Group A, n = 26), all by one surgeon. Independent evaluators analysed standardised photographs before and one year after surgery for projection, columellar height and scar quality on the Stony Brook scale.

Sections of note

52 patients, 26 per group, single surgeon, one-year photographs.
Projection improvement was greater with the V-shaped incision after adjusting for baseline (adjusted p = 0.002).
Columellar height gain was greater with the V-shaped incision (p < 0.001).
Regression confirmed incision type as an independent predictor of projection change.
Scar scores did not differ (p = 0.557). Level of Evidence II.

What it means for a patient

In a contracted, short nose, where the incision is placed can affect how much the tip can be brought forward.
The V-Y closure recruits lip skin into the columella, which in this study lengthened it without a worse scar.
Results apply to severe reconstructive cases, not routine cosmetic rhinoplasty.

Why this paper matters

It is a prospective comparison of an incision strategy for the hardest reconstructive cases, with independent scar rating. Limits: 52 patients, one surgeon, one-year follow-up, allocation method not stated.

Terms

Columella: the strip of tissue between the nostrils.
V-Y closure: a technique in which a V-shaped flap is advanced and closed as a Y to gain length.
Tip projection: how far the tip stands out from the face.
Stony Brook Scar Evaluation Scale: a validated 0-5 photographic scar score.

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

Abstract

Background: Reconstructive rhinoplasty for severely deformed noses requires meticulous technique. While reusing mid-columellar incisions is a common practice, a V-shaped columella-labial incision with V-Y closure may provide superior results. We conducted a prospective study to compare the outcomes of these two approaches.

Methods: This study included 52 patients (n = 26 per group) who underwent reconstructive rhinoplasty. Group A received a V-shaped columella-labial incision, while Group B received a mid-columellar incision. All surgeries were performed by the same surgeon. Standardized pre- and one-year postoperative photographs were analyzed for changes in nasal projection, columellar height, and scar quality (Stony Brook Scar Evaluation Scale) by independent evaluators.

Results: The V-shaped incision group demonstrated significantly greater improvement in nasal projection after adjustment for baseline differences (adjusted p = 0.002) and greater columellar height gain (p < 0.001) compared with the mid-columellar group. Linear regression analysis confirmed that columellar incision type remained an independent predictor of projection change after controlling for preoperative projection. Scar assessments showed no significant difference between groups (p = 0.557).

Conclusion: The V-shaped columella-labial incision provides significantly greater improvement in nasal projection and columellar height without increasing scar-related concerns. This technique demonstrates reliability as an initial approach for managing severely compromised nasal structures, though further studies are warranted.

Level Of Evidence Ii: 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).