Columellar Necrosis Following Rhinoplasty: A Case Report Associated with Nicotine Exposure

Abstract

Introduction: Nasal columella reconstruction presents complexities due to the distinctive vascular supply of the region and the lack of adjacent tissue. This procedure is essential for preserving both the aesthetic and functional integrity of the nose.

Methods: On this  case report highlights the difficulties encountered in columella reconstruction, especially in patients with important comorbidities, including heavy smoking. A 59-year-old heavy smoker underwent rhinoplasty, resulting in postoperative columellar ischemia and necrosis, despite several reconstructive attempts utilizing forehead, buccal mucosa, and nasolabial flaps.  Smoking adversely affects wound healing by diminishing oxygen supply, causing microvascular injury, and weakening immune responses, which increases the likelihood of tissue necrosis and infections. The application of tadalafil, a phosphodiesterase type 5 inhibitor, was investigated for its potential to improve blood flow and reduce ischemia in high-risk populations, such as smokers. Notwithstanding these interventions, the attainment of optimal vascularization continued to pose challenges.  

Results: The efficacy of the nasolabial flap in this context emphasizes the necessity of choosing suitable reconstructive methods customized to the specific requirements of each patient. Nasolabial flaps offer superior color and texture compatibility while minimizing aesthetic disturbance.

Conclusions: This case highlights the necessity of a comprehensive strategy in addressing complex rhinoplasty scenarios, particularly those involving impaired tissue perfusion. Recognizing smoking as a significant factor in wound healing is crucial for enhancing surgical outcomes. The research indicates that preoperative smoking cessation is an essential approach to minimize complications and improve recovery in plastic surgery procedures.