Columellar lengthening with V-Y advancement flap in aesthetic rhinoplasty

Achieving a harmonious nasal shape requires balance from the frontal, lateral, and basal views. A short columella can lead to inadequate tip projection and drooping. While various methods have been used to lengthen a short columella in cleft lip and palate cases, adapting these techniques for aesthetic surgery presents challenges. This report outlines the design and surgical considerations for this issue. Ten patients with a short columella at risk of skin resistance or retraction were evaluated. The V-Y flap technique was employed, featuring a V-shaped design starting at the midpoint between the columellar footplate and the lowest point of the nostril sill. Standard techniques included a columellar graft to prevent narrowing. The rhomboid flap was trimmed and sutured in place. Results showed that the V-Y flap provided adequate tip projection, reduced columellar flaring, and improved nostril shape. Scarring was comparable to an inverted-V incision, with improvements in the columellar base and philtrum and high patient satisfaction. The technique effectively addressed tip projection challenges in patients with short columella.