COSMETIC

Controlling Nasal Tip Projection and Rotation with

New Composite Septocolumellar Flap Approaches
Güncel Öztürk, M.D.

Background: Rhinoplasty is one of the most common and challenging surgeries

İstanbul, Turkey in the field of aesthetic surgery. For obtaining an aesthetically pleasing nose, it
is extremely important to control nasal tip projection and rotation as much as
possible. Since the last decade, septocolumellar suture techniques have been
most frequently used for modifying and controlling nasal tip rotation and pro-
Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 04/07/2022

jection and for obtaining a better columellar–labial angle during rhinoplasty.

In the present study, the author has described 10 different approaches using
composite septocolumellar flaps with the aim of obtaining better outcomes,
such as the control of nasal tip projection and rotation, in addition to obtaining
better tip refinement.
Methods: The records of 68 patients were included in the present study based
on the inclusion and exclusion criteria. Ten composite septocolumellar flap
approaches were followed by the same surgeon.
Results: The initial median Rhinoplasty Outcome Evaluation score was 60.5
points; the score increased to 92.5 points at 12 months after the surgery
(p < 0.001). Satisfaction was excellent in 87.5 percent of the patients. The
patients were also evaluated in terms of functionality. Their patency scores
increased from 6.0 to 9.0 (out of 10) after a 12-month follow-up (p = 0.001).
Conclusions: The technique has the following advantages: control of nasal tip pro-
jection and rotation, fixation of mild deviations, and shortening of the nose with
better aesthetic and functional outcomes. Furthermore, because the septocolu-
mellar region is completely protected and remains solid, a dynamic nasal tip is
obtained. Surgeons will be able to choose the most suitable approach when a com-
posite septocolumellar flap is needed.  (Plast. Reconstr. Surg. 149: 669e, 2022.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

T
he numbers of rhinoplasties have increased
over the past two decades, and plastic sur-
geons have attempted to create new tech-
niques for improving short-term and long-term
outcomes.1 The purpose of nasal tip surgery is to
create an aesthetically and functionally superior
nasal tip. Considerable tissue support is essential
to achieve this goal.2,3
For obtaining an aesthetically pleasing nose, it
is extremely important to control nasal tip projec-
tion and rotation as much as possible.4 Since the
last decade, septocolumellar suture techniques
have been most frequently used for modifying and
controlling nasal tip rotation and projection and
for obtaining a better columellar–labial angle dur-
ing rhinoplasty.5 Septocolumellar suturing fixes
From private practice.
Received for publication June 6, 2020; accepted July 21,
2021.
Copyright © 2022 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000008970
the medial crus of the lower lateral cartilage to
the caudal septum.5,6 Once septocolumellar sutur-
ing is performed, the position of the medial crus
on the caudal septum can be partially controlled.
Several septocolumellar grafting techniques
have been reported in the literature. Rohrich et
al. described a classification and algorithm for the
application of columellar strut grafts.7 The utiliza-
tion of type 3 (long and floating) and type 4 (long
and fixed) grafts is recommended to increase
nasal tip projection.7 However, the columella
created using this technique would be fixed and
rigid. This rigidity would pose a long-term prob-
lem for the patients,7–9 even if tip projection could
Disclosure: The author has no financial interest to
declare in relation to the content of this article.
Related digital media are available in the full-text
version of the article on www.PRSJournal.com.

www.PRSJournal.com 669e
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 Plastic and Reconstructive Surgery • April 2022

be controlled with transdomal and interdomal
sutures.10,11 Some studies have also criticized these
methods in terms of their undesirable long-term
outcomes.1
In this article, the author describes 10 differ-
ent approaches using composite septocolumellar
flaps with the aim of obtaining better outcomes,
such as the control of nasal tip projection and
rotation, in addition to obtaining better tip
refinement.
PATIENTS AND METHODS
Participants
In the present study, the records of 112
patients who were admitted to a private clinic
for rhinoplasty were retrospectively assessed. The
inclusion criteria were as follows: having unoper-
ated nasal deformities and being willing to share
medical records for scientific purposes. Patients
whose records were insufficient for the present
study and those who did not provide permission
for the use of their clinical data were excluded.
Based on the inclusion and exclusion criteria, the
records of 68 patients (55 women and 13 men)
were ultimately included in the study. The median
age of the patients was 26.2 years. All the included
patients completed the Rhinoplasty Outcome
Evaluation questionnaire before the surgery
and at their 1-year follow-up appointment. The
follow-up period was between 12 and 21 months
(median, 15.1 months). The same surgeon per-
formed all the procedures between August 1,
2017, and June 30, 2019. All the procedures were
performed under general anesthesia.
The present study was performed according to
the standards for biomedical research on human
subjects set by the Declaration of Helsinki. Before
the surgery, all the patients were informed that
their photographs could be published for scien-
tific purposes. All the patients whose records were
used in the present study have provided written
informed consent.
questions about nasal aesthetics and function.
The answers are scored between 0 and 4 points,
with 4 being the best score. The final score is mul-
tiplied by 100 after being divided by 24. A final
score greater than 85 is accepted as an excellent
score and denotes high patient satisfaction.
Subjective evaluation was performed using a
questionnaire in which each patient rated their
breathing quality with a respiratory score rang-
ing from 1 (poor) to 10 (excellent). The patency
score was assessed on the basis of these data before
and after the surgery.
Surgical Procedures
In the present study, the following 10 com-
posite septocolumellar flap approaches were fol-
lowed by the same surgeon:
1. In the first approach, the posterior strut
graft was slid upward with the septocolumel-
lar (mucoperichondrial) tissue and sutured
to the distal part of the septum. The nasal
tip projection was increased (Fig. 1).
2. In the second approach, the posterior strut
graft was slid downward with the septocolu-
mellar (mucoperichondrial) tissue, which
was bound to the columella and sutured to
the septum. The nasal tip projection was
decreased (Fig. 2).

Assessment Tools
The patients were evaluated using the
Rhinoplasty Outcome Evaluation questionnaire
before the surgery and 12 months after the sur-
gery. The Rhinoplasty Outcome Evaluation ques-
tionnaire is an objective instrument designed to
assess patients’ postoperative satisfaction with
their rhinoplasty results.12 It is a useful tool for
objectively assessing the rhinoplasty results in Fig. 1. First approach for composite septocolumellar flap and
both private and research settings. It includes six increasing nasal tip projection.

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 Volume 149, Number 4 • New Septocolumellar Flap Approaches
Fig. 2. Second approach for composite septocolumellar flap and
decreasing nasal tip projection.
3. In the third approach, once the cartilage
from the distal septum was excised as an
inverse triangle, the posterior strut graft
was attached to the medial crus of the lower
lateral cartilage with the septocolumellar
(mucoperichondrial) tissue and sutured to
the distal part of the septum. The length of
the nose was reduced, and the nasal tip rota-
tion was increased (Fig. 3).
4. In the fourth approach, once the cartilage
from the distal septum was excised as a tri-
angle, the posterior strut graft was attached
to the medial crus of the lower lateral car-
tilage with the septocolumellar (mucoperi-
chondrial) tissue and sutured to the distal
part of the septum. The nasal tip rotation
was decreased (Fig. 4).
5. In the fifth approach, once the cartilage
from the distal septum was excised as an
inverse triangle, the posterior strut graft
was attached to the medial crus of the lower
lateral cartilage with the septocolumellar
(mucoperichondrial) tissue and sutured to
the distal part of the septum by sliding in
the upward direction. The nasal tip projec-
tion and rotation were increased, the length
of the nose was reduced, and the nasolabial
angle was increased (Fig. 5).
6. In the sixth approach, once the carti-
lage from the distal septum was excised
Copyright © 2022 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Fig. 3. Third approach for composite septocolumellar flap,
shortening of the nose and increasing nasal tip rotation.
as a triangle, the posterior strut graft was
attached to the medial crus of the lower
lateral cartilage with the septocolumellar
(mucoperichondrial) tissue and sutured
to the distal part of the septum by sliding
in the downward direction. The nasal tip
projection and rotation and the nasolabial
angle were decreased (Fig. 6).
7. In the seventh approach, once the cartilage
from the distal septum was excised as a rect-
angle, the posterior strut graft was attached
to the medial crus of the lower lateral car-
tilage with the septocolumellar (mucoperi-
chondrial) tissue and sutured to the distal
part of the septum. The length of the nose
was reduced (Fig. 7).
8. In the eighth approach, once the cartilage
from the distal septum was excised as a rectan-
gle, the posterior strut graft was attached to the
medial crus of the lower lateral cartilage with
the septocolumellar (mucoperichondrial) tis-
sue and sutured to the distal part of the sep-
tum by sliding in a downward direction. The
length of the nose was reduced. Moreover, the
nasal tip projection was decreased (Fig. 8).
9. In the ninth approach, once the cartilage from
the distal septum was excised as a rectangle,
the posterior strut graft was attached to the
medial crus of the lower lateral cartilage with
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 Plastic and Reconstructive Surgery • April 2022

Fig. 4. Fourth approach for composite septocolumellar flap and Fig. 5. Fifth approach for composite septocolumellar flap, short-
decreasing nasal tip rotation. ening of the nose and increasing the degree of the nasolabial
angle.
the septocolumellar (mucoperichondrial) tis-
sue and sutured to the distal part of the sep-
tum by sliding in an upward direction. The
length of the nose was reduced. Moreover,
the nasal tip projection and rotation and the
nasolabial angle were increased (Fig. 9).
10. In the tenth approach, in nondeviated
septums, the posterior strut graft is end-
to-end sutured in an “8” shape (approach
10A) (Fig.  10, left). In mildly deviated
septums, the posterior strut graft is slid
and sutured in loop shape to the left or
right side of the septum (approach 10B)
(Fig. 10, right).

Table 1 summarizes applicability of composite

septocolumellar flap approaches on certain cases.
Table  2 shows variations of composite septo-
columellar flap approaches according to several
aesthetic special needs.
The surgery was performed under general
anesthesia. Adrenaline was injected at a dilu-
tion of 1:100,000. The author proceeded to per-
form a closed rhinoplasty. In the first stage, nasal
tip plasty is performed. In the second stage, the
hump is reduced. Fig. 6. Sixth approach for composite septocolumellar flap,
A unilateral transfixion incision was made, decreasing nasal tip projection and rotation and decreasing the
and subperichondrial dissection was performed nasolabial angle.

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 Volume 149, Number 4 • New Septocolumellar Flap Approaches
Fig. 7. Seventh approach for composite septocolumellar flap
and shortening of the nose.
Fig. 8. Eighth approach for composite septocolumellar flap,
shortening of the nose, decreasing of the nasal tip projection
Copyright © 2022 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Fig. 9. Ninth approach for composite septocolumellar flap,
shortening of the nose and increasing nasal tip projection, rota-
tion, and nasolabial angle.
at the caudal part of the septum. A 2-mm-wide
cartilage was left at the distal part of the septum,
and a longitudinal incision was made. The carti-
lage (posterior strut graft) on the distal septum
was attached to the columella with mucoperi-
chondrial tissues (Fig. 11, left). Additional carti-
lage at the distal part of the septum was marked
for excision. A longitudinal excision is made
(Fig. 11, center). The posterior strut graft, which
was attached to the columella with mucoperi-
chondrial tissues, was sutured to the septum.
As shown in Figure  11 (right), the patient had
deviation toward the left side, which was fixed by
suturing the posterior strut graft after sliding it
to the right side and suturing the selected region
with three sutures. Nasal tip projection can be
controlled by replacing the upper or lower side
of the posterior strut graft.
Presurgical Anatomic Characteristics for
Decision Making
Approach 1 can be used while the nose has
normal length and low projection; thus, an
increase of nasal tip projection will be obtained.
Approach 2 can be used in patients with a nor-
mal nose length and high projection to obtain a
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Fig. 10. Tenth approach for composite septocolumellar flap and fixation of nondeviated (left) or deviated (right) noses, approaches
10A and 10B, respectively.
decreased nasal tip projection. Approach 3 can be
applied if patient has a long nose and low rotation.
This approach will lead to shortening of the nose
and increasing the nasal tip projection. Approach
4 can be used in patients with normal nose length
and high rotation to provide a decreased nasal tip
rotation. If patient has a long nose and low pro-
jection and rotation, approach 5 will be suitable.
Approach 5 will lead to obtaining the shortening
of the nose and increasing the nasal tip’s projec-
tion and rotation. If the nose has normal length
and high projection and rotation, approach 6
will be suitable for decreasing the nasal tip rota-
tion and projection. If the nose is long, approach
7 can be performed to shortening the length
of nose. If the nose is long and has high projec-
tion, approach 8 will be useful for shortening the
length of the nose and decreasing the projection
of nasal tip. If the nose is long and has low pro-
jection, approach 9 can be performed to increase
the nasal tip projection and shorten the length of
the nose. Approach 10 can be applied in two ways.
It can be applied in straight noses and “8”-shaped
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Plastic and Reconstructive Surgery • April 2022
suturing can be performed in the septocolumellar
region, and possible deviation can be prevented.
An alternative in approach 10 can be used in devi-
ated noses.
[See Video (online), which demonstrates the
effects of the composite septocolumellar flap on
nasal projection, rotation, and deviation on the tip
of the nose. It also shows preoperative and postop-
erative status of a sample patient from front and
side views.]
Statistical Methods
The data were analyzed using the SPSS Statistics
for Windows, version 17.0 (SPSS, Inc., Chicago,
Ill.). A confidence interval of 95 percent and a two-
tailed p value less than or equal to 0.05 indicated
statistical significance. Descriptive data are given
as medians and percentages. Numerical data were
analyzed with the Shapiro–Wilk test to determine
whether they were parametric. The Rhinoplasty
Outcome Evaluation and patency scores were
found to be nonparametric; hence, the Wilcoxon
signed rank test was used to assess the difference
 Volume 149, Number 4 • New Septocolumellar Flap Approaches

Table 1.  Variations of Septocolumellar Flap was rated as excellent in 87.5 percent of the
Approaches included patients.
Issue to Address Approach
The patients were also evaluated in terms of
functionality. Their patency scores increased from
Projection
 Increase Figs. 1, 5, and 9 6.0 to 9.0 (out of 10) after a 12-month follow-up
 Decrease Figs. 2, 6, and 8 (p = 0.001). The preoperative and 12-month and
Rotation following postoperative images of the patients are
 Increase Figs. 3 and 5
 Decrease Figs. 4 and 6 provided in Figures 12 and 13 and Supplemental
Shortened nose Digital Content Figures 1 and 2, respectively.
 Yes Figs. 3, 5, 7, 8, 9, and 10, right (See Figure, Supplemental Digital Content 1,
 No Figs. 1, 2, 4, 6, and 10, left
Deviation which shows preoperative lateral view of a sample
 Yes Fig. 10, right patient, lateral view at 6 months, and lateral view
 No Fig. 10, left
at 18 months. For this 27-year-old, male patient,
approaches 4 and 10A were applied, http://links.
lww.com/PRS/E948. See Figure, Supplemental
Table 2.  Applicability of Septocolumellar Flap Digital Content 2, which shows preoperative lat-
Approaches on Certain Cases eral view of a sample patient, lateral view at 10
Approach Applicability months and lateral view at 18 months. For this
Approach 1 Nose is normal length with low projection
32-year-old female patient, approaches 5 and 10B
Approach 2 Nose is normal length with high projection were applied, http://links.lww.com/PRS/E949.)
Approach 3 Nose is long with low rotation There were no complications. Moreover, there
Approach 4 Nose is normal length with high rotation
Approach 5 Nose is long with low projection and rotation was no need for revision surgery.
Approach 6 Nose is normal length with high projection The Rhinoplasty Outcome Evaluation scores
and rotation of the first nine groups were compared, and it was
Approach 7 Nose is long
Approach 8 Nose is long with high projection found that there were no significant differences
Approach 9 Nose is long with low projection among the groups (p = 0.73). The 10A and 10B
Approach 10A Straight nose approaches were also compared and resulted as
Approach 10B Deviated nose
insignificant (p = 0.61). The Rhinoplasty Outcome
Evaluation scores of each group are presented at
in the patency scores before and after the sur- Table 3.
gery. Twelve months after surgery, Rhinoplasty
Outcome Evaluation scores of approaches 1 to 9
DISCUSSION
were compared with the Kruskal-Wallis test. The
Mann-Whitney U test was used for comparison of The shape, rotation, and projection of the
twelfth month Rhinoplasty Outcome Evaluation nasal tip after rhinoplasty are considered to be
scores of the two options in approach 10. the most essential factors associated with better
short-term and long-term aesthetic outcomes. In
the present study, the author presents 10 different
RESULTS composite septocolumellar flap approaches that
The median age of the patients was 23.2 years protect the mucoperichondrial tissue. The results
(range, 18 to 27 years). At 12 months after the suggest that the technique can allow rhinoplasty
surgery, no patient needed revision surgeries. surgeons to control nasal tip rotation and pro-
Physical examination and the assessment of post- jection, fix mildly deviated or nondeviated noses
operative photographs showed no instances of with less aggressive interventions, and reduce the
asymmetry. The postoperative results were consid- length of the nose.
ered satisfactory. In clinical practice, septocolumellar suturing
The follow-up period was between 12 and techniques are crucial for achieving the desired
18 months (median, 15.1 months). The same shape and position of the nasal tip.4 These tech-
surgeon (G.Ö.) performed all the procedures niques involve parts such as the lower lateral carti-
between August 1, 2017, and June 30, 2019. The lage and nasal septum. Hence, structural aspects of
Rhinoplasty Outcome Evaluation scores ranged the nasal septum [e.g., its height, length, shape, and
from 80 to 100 points after 1 year. The initial thickness (stability)] should be taken into account.4
median Rhinoplasty Outcome Evaluation score The caudal part of the septal cartilage plays an
was 60.5 points; it increased to 92.5 points at 12 important role in septocolumellar suturing tech-
months after the surgery (p < 0.001). Satisfaction niques and in the final reshaping of the nasal tip.

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 Plastic and Reconstructive Surgery • April 2022

Fig. 11. (Left) A unilateral transfixion incision was made, and subperichondrial dissection was performed at the caudal part of the sep-
tum. A 2-mm-wide cartilage was left at the distal part of the septum, and a longitudinal incision was made on the septum. The cartilage
(posterior strut graft) on the distal septum was attached to the columella with mucoperichondrial tissues. (Center) The cartilage excised
from the distal septum is demonstrated. (Right) The posterior strut graft, which was attached to the columella with mucoperichondrial
tissues, was sutured to the septum. The posterior strut graft was sutured to the opposite side of deviated septum with three sutures.

However, if surgeons follow a standard technique
for septocolumellar interventions, there can be
unexpected short-term or long-term outcomes. For
example, if the septum is too short, there can be a
risk of columellar retraction after septocolumellar
grafting. Hence, different approaches should be
followed according to patients’ needs during sep-
tocolumellar grafting or suturing.
Several grafting techniques have been
described for the creation of a permanent nasal tip
and for the prevention of postoperative descent of
the nasal tip. These include the use of extended
spreader grafts, batten grafts, and direct extension
grafts.13–15 However, there is no standard protocol
for these interventions. Autogenous cartilage grafts
are commonly regarded as the gold standard for
grafting during nasal surgeries. Furthermore, sep-
tal and conchal cartilages have been commonly
used as donor sources in rhinoplasties.16–19
In these approaches, the length of the nose is
adjusted according to the nasal tip projection and
nasolabial angle. Thus, adjustment of the length of
the nose is the last stage of the surgery. The order
of the interventions is as follows: in the first stage,
nasal tip plasty is performed. In the second stage,
the hump is reduced. A 2-mm-wide cartilage is left
intact at the distal part of the septum with trans-
fixion and superior short cut incisions, reaching

Fig. 12. (Left) Preoperative lateral view of a sample patient. (Center) Lateral view at 8 months. (Right) Lateral view at 16 months. The
patient was a 27-year-old woman for whom approaches 2 and 10B were applied.

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 Volume 149, Number 4 • New Septocolumellar Flap Approaches

Fig. 13. (Left) Preoperative lateral view of a sample patient. (Center) Lateral view at 4 months. (Right) Lateral view at 17 months. The
patient was a 24-year-old woman for whom approaches 3 and 10B were applied.

to the middle and superior parts. In the last stage,
surgeons can choose from 10 different approaches
according to the patients’ needs. At the end of the
surgery, the silhouette and length of the nose and
nasal tip projection and rotation are checked. If the
nose is long, the cartilage is excised from the distal
part of the septum. If further excision is needed,
additional cartilage is excised from the caudal part
of the upper lateral cartilage. Moreover, if the sur-
geon decides that further excision is needed, the
anterior nasal spine is partially or totally excised.
If a patient needs nasal tip rotation, the cartilage
is excised in the form of an inverse triangle from
the distal part of the septum. If additional rotation
is needed, the cartilage is excised from the upper
lateral cartilage for increased rotation. If a patient
needs nasal tip projection, ligament connections
linked to the anterior nasal spine are released from
the posterior strut graft within composite septocol-
umellar flap for increasing the mobilization toward
the upper side. Finally, the posterior strut graft is
sutured to the caudal part of the septum with triple
or quadruple 5/0 polydioxanone suture. In these
approaches, there is slight load on the posterior
strut graft. The main support is provided by the
strut graft placed between the medial crura.
The posterior strut graft within the composite
septocolumellar flap is sutured endto end to the
caudal part of the septum with a figure-of-8 suture
in nondeviated noses. In deviated noses, the flap is
sutured as a loop to the opposite side of the devia-
tion. Moreover, the nasal valve is not obstructed at
the area of suture. These approaches are suitable
for fixing nasal tip deviation. However, in the case
of moderate or severe dorsal deviation, additional
interventions should be considered.

Table 3.  Demonstration of Rhinoplasty Outcome Evaluation Scores for the 10 Approaches
No. % Median IQR
Approach 1 8 11.7 90.00 88.00–95.00
Approach 2 5 7.3 92.00 90.00–96.00
Approach 3 11 16.2 88.00 86.00–93.00
Approach 4 5 7.3 91.00 87.00–91.00
Approach 5 12 17.6 89.00 86.00–94.00
Approach 6 5 7.3 93.00 89.00–96.00
Approach 7 8 11.7 89.00 87.00–93.00
Approach 8 4 5.9 92.00 88.00–95.00
Approach 9 10 14.7 87.00 85.00–91.00
Total 68 100
Approach 10A 23 33.8 92.00 90.00–96.00
Approach 10B 45 66.2 91.00 89.00–95.00
Total 68 100
IQR, interquartile range.

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The posterior strut graft cut from the distal
part of septum is sutured to the caudal part of
the septum in a composite septocolumellar flap.
The soft tissue between the posterior strut graft
and medial crus remains intact and supports the
mobility of the nasal tip. The soft tissue may slide
down with time due to the effect of gravity. There
is a slight load on the composite septocolumellar
flap. If there is severe load on this flap, there will
be an undesirable outcome, such as the descent
of the nasal tip. The main support is provided by
the strut graft placed between the medial crura.
Two patients experienced minimal descent of the
nasal tip; however, there was no need for revision
surgery in these patients.
A composite septocolumellar flap is used to
control nasal tip projection, rotation, and mobil-
ity and to fix nasal tip deviations. If composite
septocolumellar flaps are used according to an
algorithm, there would be no distortion or devel-
opment of a bulge, which can occur with these
composite septocolumellar flap approaches.
These approaches will not restrict functional
surgery of the septum or turbinates, except in
extreme cases such as severe septal deviation.
The septocolumellar suture technique is a pre-
ferred method that mediates the medial crura and
the caudal part of the septum. Septocolumellar
surgery helps decrease or increase nasal tip rota-
tion. Moreover, with appropriate cartilage, it
helps rotate the nasal tip and columella accord-
ing to the patients’ needs; it can thus have several
applications. Tezel and Ersoy4 described different
septocolumellar sutures for modifying the rela-
tionship between the lower lateral cartilage and
the nasal septum; the present study demonstrates
novel and easy approaches for septocolumellar
surgery based on composite septocolumellar flaps
rather than suturing. Ten different approaches
are described, and in all approaches, the mucop-
erichondrial soft tissues are protected.
The retrospective design of the present study
may be considered a limitation. Another limi-
tation could be that the number of participants
included in the study can be considered too small
to reach a general conclusion.
CONCLUSIONS
The present study is the first to demonstrate
different approaches using composite septocolu-
mellar flaps for improving short-term and long-
term outcomes of rhinoplasty. Surgeons will be
able to choose the most suitable approach when
composite septocolumellar flaps are needed.
678e
Copyright © 2022 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Plastic and Reconstructive Surgery • April 2022
Güncel Öztürk, M.D.
Nişantaşı Abdi İpekçi Cad. No. 24/4
İstanbul, Turkey 34367
drgunceloz@gmail.com
Instagram: @guncelozturk
PATIENT CONSENT
Patients provided written informed consent for the
use of their images.
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