Philtrum Fasciocutaneous Advancement Flap for Columellar Reconstruction in Revision Rhinoseptoplasty

OBJECTIVE: To evaluate the anatomical suitability of the philtrum fasciocutaneous advancement flap (PFCAF) for columellar reconstruction and its clinical applicability in revision rhinoseptoplasty and nasal reconstruction. METHODS: A descriptive study was conducted, comprising two components: (i) an anatomical analysis of 115 healthy adults to determine the feasibility of the philtrum as a donor site based on craniofacial measurements, and (ii) a clinical study of eight patients who underwent columellar reconstruction using a PFCAF. Sex-based differences were analyzed. To explore a potential dual benefit (reconstruction plus aesthetic improvement), residual philtrum length after hypothetical advancement was estimated, considering 11-13 mm in women and 13-15 mm in men as aesthetically favorable. RESULTS: Mean philtrum length was greater in men than in women (16.27 ± 3.9 mm vs. 14.84 ± 2.86 mm; p < 0.05). In 91.9% of individuals, philtrum area exceeded the combined area required to reconstruct the columellar and footplate polygons (p < 0.05). Based on anatomical simulations, approximately 25% of subjects would be expected to remain within the predefined aesthetic range after advancement. Clinically, all eight PFCAF procedures were completed in a single stage with no flap necrosis, infection, or dehiscence and with satisfactory restoration of columellar coverage and projection. CONCLUSION: PFCAF is a versatile and reliable single-stage option for columellar reconstruction in revision rhinoseptoplasty. Anatomical data support broad applicability, and the clinical series demonstrates safety and effective restoration of columellar coverage; careful preoperative assessment is required to optimize functional and aesthetic outcomes.