Journal archive · Revision and secondary rhinoplasty · Nasal tip · Complications and management · 2026
Revision Rhinoplasty in Retrocolumellar Perforation
Göde S, Aliyeva A, Apaydın MB, Azizli E.
What this paper says
In 28 revision patients with a hole behind the columella, repair with endonasal or gingivobuccal flaps plus rib cartilage closed the perforation in 96.4% and lifted SCHNOS scores from 18.2 to 89.4.
Overview
Retrocolumellar perforation is a rare complication of earlier rhinoplasty that leaves a defect behind the columella, with a retracted columella, short nose and lost tip projection. The authors treated 28 patients (mean age 35.6; 17 men, 11 women) using vascularised flaps chosen according to what was found at surgery, with rib cartilage grafts in every case.
Sections of note
- 71.4% had two or more prior nasal surgeries; 64.3% smoked and 35.7% used cocaine.
- All had contracted nasal skin, a short nose and a retracted columella.
- Perforation closed in 27 of 28 (96.4%).
- Stable tip projection in 23 of 28 (82.1%); 4 developed drooping tips despite closure.
- SCHNOS improved from 18.2 (SD 8.5) to 89.4 (SD 10.7), p < 0.001.
- Among 18 patients repaired with gingivobuccal flaps, 16 (88.9%) kept stable projection, a trend not proven superior.
What it means for a patient
- This is a severe, uncommon revision problem, usually after multiple operations and often with smoking or cocaine use.
- Repair needs living tissue flaps for lining plus rib cartilage for support, not grafts alone.
- In this series closure was near-universal but about 1 in 6 patients still had tip droop.
Why this paper matters
It is the largest reported series of this specific complication and describes a flap-based algorithm. Limits: retrospective, single group, no comparison of flap types beyond a trend.
Terms
- Retrocolumellar perforation: a hole in the septum immediately behind the columella.
- Vascularised flap: tissue moved with its own blood supply, needed to heal in scarred beds.
- Gingivobuccal flap: lining tissue taken from inside the upper lip and cheek.
- Endonasal flap: lining tissue moved from inside the nose.
- SCHNOS: a validated nasal outcome questionnaire covering obstruction and cosmesis.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
Abstract
Background: Retrocolumellar perforations (RCPs) are rare complications of revision rhinoplasty, often associated with columellar retraction, shortened nasal length, and loss of tip projection. Their repair requires vascularized flaps that provide both mucosal coverage and structural support at the tip.
Objective: To evaluate the surgical outcomes of RCP repair using endonasal and gingivobuccal flaps, with emphasis on perforation closure, nasal tip projection, and patient-reported outcomes.
Methods: A cohort of 28 patients (mean age 35.6 years; 17 men, 11 women) underwent RCP repair. Most had ≥ 2 prior nasal surgeries (71.4%). Risk factors included smoking (64.3%) and cocaine use (35.7%). All patients had nasal skin contraction, short noses, and a retracted columella. Flap techniques were selected according to intraoperative anatomy, and rib cartilage grafts were used in all cases. Outcomes were assessed by perforation status, nasal tip projection, and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS).
Results: Perforation closure was achieved in 27 of 28 patients (96.4%). Stable and desired nasal tip projection was maintained in 23 patients (82.1%), whereas 4 patients had drooping nasal tips despite RCP closure. SCHNOS scores improved significantly from 18.2 ± 8.5 preoperatively to 89.4 ± 10.7 postoperatively (p < 0.001, Cohen's d = 3.68). Among patients reconstructed with gingivobuccal flaps (n = 18), 16/18 (88.9%) maintained stable tip projection, suggesting a favorable trend but not demonstrating superiority.
Conclusion: RCP repair using structured vascularized flaps achieves high closure rates, reliable nasal tip support, and significant functional and cosmetic improvement. Gingivobuccal flaps are particularly valuable in revision cases with compromised anterior support.
Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Revision and secondary rhinoplasty
Between 5% and 15% of rhinoplasties are done again, and the published series say the second operation is a different problem from the first: the cartilage is gone, the skin is scarred and less able to survive, and the airway is usually part of the complaint.
Nasal tip
Tip surgery is now a support problem rather than a sculpting problem: the septal extension graft holds projection and rotation where the columellar strut loses them (0.2% against 4.7% projection loss at one year), and the current series repair, reposition and reinforce the lower lateral cartilages instead of excising them.
Complications and management
Serious complications after rhinoplasty are rare: infection runs under 1% in the two largest single-surgeon series, pooled rib harvests record no pneumothorax, and the bleeding series record no thromboembolism.
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