INTRODUCTION: Infection, improper dissection, trauma, or excessive tension on the columellar closure can result in necrosis of the columella. Maneuvers such as advancing the base of the columella anteriorly or using a Silastic healing chamber can help prevent columellar necrosis. OBJECTIVE: Reconstruction of columellar defects is complex and may involve the recruitment of upper lip tissue, composite grafting, or the use of local or regional flaps. Structural grafting using autologous cartilage provides the necessary structural support to achieve a long-term esthetic and functional outcome. METHODS: Chart review and data analysis. RESULTS: All cases resulted in successful reconstruction. Two complications were noted in 34 cases. CONCLUSIONS: Avoiding tension on the columellar closure can help to prevent necrosis. Columellar reconstruction may require Silastic healing chamber, grafts or flaps. In the author's experience, nanofat and hyperbaric oxygen are frequently used to maximize outcomes in prevention and management of columellar necrosis.
Dean M. Toriumi (2026) studied this question.