Columella lengthening with skin supply is an essential tool in structure, ethnic, custom, revision and reconstructive rhinoplasties, whenever the nasal columella is short due to cutaneous causes and skin shortfall.
The columella itself needs good internal skeleton to support its optimal length but, additionally, the skin cover has to be large and long enough to allow its size; when the columella length has to be increased by means of grafting at the medial cruras like struts or others, sometimes boosted by a septal lengthening in a lower or caudal direction, the skin at the columella may reach its maximum grade of expandability and therefore lead to a real skin shortfall which may cause the failure of the skeletal augmentation, deformities or even healing breakdown.
In such scenario the cutaneous cover of the columella has to be supplemented with locally supplied flaps mobilizing skin from the surrounding areas; there are different methods and strategies to lengthen the columellar skin, like zetaplasty, transposition flaps, advancement flaps, VY flaps, nasolabial flaps, etc.
It is a common association combining some kind of columellar skin lengthening with structural lengthening of the columellar skeleton.
This gesture can be done by either closed or open approach rhinoplasties, notwithstanding the open approach is a must of safety, reliability and precision for its execution.
Patients warning: only highly experienced surgeons who have underwent optimal training and have performed already a large number of closed and open approach structure and non structure rhinoplasties should execute high end rhinoplasty cases, should they feel capable and comfortable with the challenge.