Controlling Nasal Tip Projection and Rotation with New Composite Septocolumellar Flap Approaches.

[BACKGROUND] Rhinoplasty is one of the most common and challenging surgeries in the field of aesthetic surgery. For obtaining an aesthetically pleasing nose, it is extremely important to control nasal tip projection and rotation as much as possible. Since the last decade, septocolumellar suture techniques have been most frequently used for modifying and controlling nasal tip rotation and projection and for obtaining a better columellar-labial angle during rhinoplasty. In the present study, the author has described 10 different approaches using composite septocolumellar flaps with the aim of obtaining better outcomes, such as the control of nasal tip projection and rotation, in addition to obtaining better tip refinement.

[METHODS] The records of 68 patients were included in the present study based on the inclusion and exclusion criteria. Ten composite septocolumellar flap approaches were followed by the same surgeon.

[RESULTS] The initial median Rhinoplasty Outcome Evaluation score was 60.5 points; the score increased to 92.5 points at 12 months after the surgery (p < 0.001). Satisfaction was excellent in 87.5 percent of the patients. The patients were also evaluated in terms of functionality. Their patency scores increased from 6.0 to 9.0 (out of 10) after a 12-month follow-up (p = 0.001).

[CONCLUSIONS] The technique has the following advantages: control of nasal tip projection and rotation, fixation of mild deviations, and shortening of the nose with better aesthetic and functional outcomes. Furthermore, because the septocolumellar region is completely protected and remains solid, a dynamic nasal tip is obtained. Surgeons will be able to choose the most suitable approach when a composite septocolumellar flap is needed.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.