Short columella nasolabial complex in aesthetic rhinoplasty

Many papers describe different approaches for short columella in cleft lip or Negroid noses. Very little has been found in international literature related to these aesthetic rhinoplasties. The scarce skin of the columella, the firm union between the nasal tip and the lip, due to the hypertrophy of the depressor septi nasi muscle, and the low projection of the nasal tip, consequence of the open position of the caudal part of the medial crura, are the cause of this problem. Therefore, the skin, muscle, and cartilage were treated simultaneously. Herein is described a VY composite advanced flap for projecting the tip, suturing both divergent medial crura together and adding the skin and muscle tissues of the lip to the columella. With this flap the tip was projected, the columella was narrowed, the nasolabial angle improved, and the upper lip elongated. Good results could be achieved without using any other cartilage graft or silastic strut. Standard rhinoplasty and septumplasty could be combined with this technique. Inconspicuous scars were observed.