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 .
Göde et al. (Mon,) studied this question.