Fusion Sling–Superficial Orbicularis Oris Nasalis Composite Flap: A Soft-tissue Suspension Technique for Columellar Base Augmentation in Asian Rhinoplasty
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Summary: In Asian rhinoplasty, midfacial harmony often requires concurrent enhancement of the nasolabial angle and columellar base projection. Conventional structural grafts—columellar struts, septal extension grafts, and premaxillary grafts—provide reliable support but may increase tip rigidity or disturb the upper lip–columellar relationship. Recent anatomical work has identified the fusion sling and the superficial orbicularis oris nasalis (SOON) as key soft-tissue contributors to nasal tip dynamics. Between 2022 and 2025, the fusion sling–SOON composite flap (FSCF) was performed in 214 consecutive Asian rhinoplasty patients (179 primary; the remainder selected revision cases with preserved fusion sling–SOON continuity). Indications included an acute nasolabial angle with inadequate anterior nasal spine or premaxillary support. Through a sub-superficial musculoaponeurotic system approach, the fusion sling and SOON were elevated as an 8- to 10-mm fasciomuscular composite flap and stabilized with a caudal septal soft-hinge or septal extension graft suspension. Three-dimensional Vectra analysis was performed in 63 patients. Mean follow-up was 12.4 months (range, 6–24 mo). Mean nasolabial angle increased from 93.4-degree angle to 101.0-degree angle (+7.6-degree angle), and columellar base projection increased by 1.9 mm. Graded mild, moderate, and large changes were reproducibly achieved. No major complications, upper lip stiffness, animation deformities, or FSCF-related revisi
Abstract
Summary: In Asian rhinoplasty, midfacial harmony often requires concurrent enhancement of the nasolabial angle and columellar base projection. Conventional structural grafts—columellar struts, septal extension grafts, and premaxillary grafts—provide reliable support but may increase tip rigidity or disturb the upper lip–columellar relationship. Recent anatomical work has identified the fusion sling and the superficial orbicularis oris nasalis (SOON) as key soft-tissue contributors to nasal tip dynamics. Between 2022 and 2025, the fusion sling–SOON composite flap (FSCF) was performed in 214 consecutive Asian rhinoplasty patients (179 primary; the remainder selected revision cases with preserved fusion sling–SOON continuity). Indications included an acute nasolabial angle with inadequate anterior nasal spine or premaxillary support. Through a sub-superficial musculoaponeurotic system approach, the fusion sling and SOON were elevated as an 8- to 10-mm fasciomuscular composite flap and stabilized with a caudal septal soft-hinge or septal extension graft suspension. Three-dimensional Vectra analysis was performed in 63 patients. Mean follow-up was 12.4 months (range, 6–24 mo). Mean nasolabial angle increased from 93.4-degree angle to 101.0-degree angle (+7.6-degree angle), and columellar base projection increased by 1.9 mm. Graded mild, moderate, and large changes were reproducibly achieved. No major complications, upper lip stiffness, animation deformities, or FSCF-related revisions occurred. The FSCF is a reproducible, anatomy-based dynamic technique that improves the nasolabial angle and columellar base while preserving upper lip mobility, offering a balanced alternative to rigid structural augmentation in Asian rhinoplasty.