Prevention and Management of Columellar Necrosis in Rhinoplasty

Toriumi DM.

What this paper says

Toriumi reviews 34 cases of columellar tissue death after rhinoplasty, all successfully reconstructed with two complications, and stresses avoiding tension on the columellar closure to prevent it.

Overview

Necrosis (tissue death) of the columella can follow infection, poor dissection, trauma or a closure under too much tension. This chart review from a leading revision surgeon covers prevention measures, such as advancing the columellar base forward or using a Silastic healing chamber, and reconstruction methods including upper lip tissue, composite grafts and local or regional flaps, with autologous cartilage for support.

Sections of note

34 cases reviewed; all reconstructions succeeded; 2 complications.
Causes listed: infection, improper dissection, trauma, excessive tension on closure.
Preventive manoeuvres: advancing the columellar base anteriorly; a Silastic healing chamber.
Reconstruction options: upper lip tissue recruitment, composite grafting, local or regional flaps, with structural cartilage grafting.
The author frequently uses nanofat and hyperbaric oxygen in prevention and management.

What it means for a patient

Columellar necrosis is a rare but serious complication, usually of revision surgery, that can leave a visible defect.
It is preventable mainly by not closing the columella under tension.
If it happens, reconstruction is possible but complex; this series shows it can be done reliably by an expert.

Why this paper matters

It is a focused series on an uncommon complication from one of the most experienced revision surgeons. Limits: chart review, single surgeon, no control, complications not detailed in the abstract.

Terms

Columella: the tissue strip between the nostrils, cut in open rhinoplasty.
Necrosis: death of tissue from loss of blood supply.
Composite graft: skin plus cartilage taken together, usually from the ear.
Silastic healing chamber: a silicone shield placed over a wound to protect it while it heals.
Hyperbaric oxygen: breathing pure oxygen in a pressurised chamber to help compromised tissue survive.

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

From the abstract

“Infection, improper dissection, trauma, or excessive tension on the columellar closure can result in necrosis of the columella. Maneuvers such as advancing the base of the columella anteriorly or using a Silastic healing chamber can help prevent columellar necrosis. Objective: Reconstruction of columellar defects is…”

Excerpt; the full abstract is on PubMed.