Septocolumellar Anchorage in Secondary Rhinoplasty: A Cartilage-Sparing, Closed-Approach Strategy

<i>Background:</i> Secondary rhinoplasty is recognized as one of the most technically demanding procedures within the domain of facial plastic surgery. This complexity arises primarily from the presence of distorted anatomical structures, scar contracture, and compromised structural support resulting from prior surgical interventions. Such alterations frequently result in diminished nasal tip projection, malrotation, columellar retraction, deviation, and dysfunction of the internal nasal valve. Conventional revision techniques often require open surgical approaches and structural grafting, including the utilization of costal cartilage, thereby increasing both the complexity and morbidity associated with the procedure. <i>Purpose:</i> This study aims to assess the clinical efficacy and reproducibility of septocolumellar anchorage as a cartilage-preserving technique for the restoration of nasal tip support and biomechanics in secondary rhinoplasty, primarily conducted through a closed endonasal approach. <i>Methods:</i> A retrospective descriptive study was conducted involving 26 consecutive patients who underwent revision rhinoplasty between April 2022 and October 2024, subsequent to primary surgery performed by a different surgeon. The indications for revision included diminished tip projection or rotation, columellar retraction, tip deviation, and functional airway compromise. Surgical intervention was performed under general anesthesia, primarily employing intercartilaginous and hemitransfixion incisions. Following the release of scar tissue and mobilization of the lower lateral cartilages, septocolumellar sutures were anchored to the anterosuperior angle of the caudal septum to ensure stable tip support. Selective use of adjunctive septal cartilage grafts was implemented, while no costal cartilage grafts were harvested. The minimum follow-up period was 12 months. <i>Results:</i> The patient cohort ranged in age from 20 to 64 years, with a mean age of 42.7 ± 12.1 years, and an average of 1.34 prior rhinoplasty procedures. A closed surgical approach was utilized in 73% of the cases. Restoration of nasal tip projection, rotation, and alignment was successfully achieved in all patients, accompanied by a consistent enhancement in nasal airflow in instances where preoperative obstruction was present. No major complications, structural failures, or requirements for tertiary revision were reported. <i>Conclusions:</i> Septocolumellar anchorage represents a dependable and reproducible cartilage-sparing technique in secondary rhinoplasty. It offers predictable biomechanical control over nasal tip dynamics while minimizing tissue dissection and obviating the necessity for costal cartilage grafting in appropriately selected patients.