Fusion Sling-Superficial Orbicularis Oris Nasalis Composite Flap: A Soft-tissue Suspension Technique for Columellar...

In Asian rhinoplasty, midfacial harmony often requires concurrent enhancement of the nasolabial angle and columellar base projection. Conventional structural grafts-columellar struts, septal extension grafts, and premaxillary grafts-provide reliable support but may increase tip rigidity or disturb the upper lip-columellar relationship. Recent anatomical work has identified the fusion sling and the superficial orbicularis oris nasalis (SOON) as key soft-tissue contributors to nasal tip dynamics. Between 2022 and 2025, the fusion sling-SOON composite flap (FSCF) was performed in 214 consecutive Asian rhinoplasty patients (179 primary; the remainder selected revision cases with preserved fusion sling-SOON continuity). Indications included an acute nasolabial angle with inadequate anterior nasal spine or premaxillary support. Through a sub-superficial musculoaponeurotic system approach, the fusion sling and SOON were elevated as an 8- to 10-mm fasciomuscular composite flap and stabilized with a caudal septal soft-hinge or septal extension graft suspension. Three-dimensional Vectra analysis was performed in 63 patients. Mean follow-up was 12.4 months (range, 6-24 mo). Mean nasolabial angle increased from 93.4-degree angle to 101.0-degree angle (+7.6-degree angle), and columellar base projection increased by 1.9 mm. Graded mild, moderate, and large changes were reproducibly achieved. No major complications, upper lip stiffness, animation deformities, or FSCF-related revisions occurred. The FSCF is a reproducible, anatomy-based dynamic technique that improves the nasolabial angle and columellar base while preserving upper lip mobility, offering a balanced alternative to rigid structural augmentation in Asian rhinoplasty.