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

Abstract Background 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 the columella–labial incision in patients with previous mid-columellar scars and assess the functional and aesthetic outcomes of reconstructive septorhinoplasty using this strategic incision through patient-reported outcome measures and chart reviews. Methods This case series included patients with previous unsuccessful rhinoplasties and mid-columellar scars who underwent open-approach reconstructive septorhinoplasty with a columella–labial incision. Collected data included demographics, medical history, operative reports, and postoperative events. Skeletal reconstruction was performed using various autografts. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively. Results Most patients were female (68/91, 75%), with a mean age of 37.6 years and 1.74 previous rhinoplasties. The average surgery duration was 239.5 min. Autografts included auricular cartilage (64), costal cartilage (43), temporal fascia (12), and rectus fascia (24). No cases of dehiscence or vascular complications occurred, even in patients with multiple previous mid-columellar incisions. SCHNOS scores significantly improved, with obstruction scores decreasing from 52.86 to 18.43 (standard deviation [SD] = 8.33 vs 3.95) and cosmesis scores from 78.09 to 20.19 (SD = 6.44 vs 5.13). Conclusions The V-shaped columella–labial incision does not increase the risk of vascular compromise, even in patients with mid-columellar scars. Its strategic use facilitates skeletal reconstruction while effectively improving nasal contour and columellar length with acceptable scarring. Level of Evidence: 4 (Therapeutic)