Background <p>Columellar defects, resulting from trauma or surgery, pose both functional and aesthetic challenges. This study evaluates the functional and aesthetic outcomes of columellar reconstruction using the philtral flap method in a case series of fourteen patients with columellar defects, focusing on respiratory and aesthetic outcomes.</p> Methods <p><i>Participants</i>: Fourteen patients with columellar defects. <i>Procedure</i>: Costal cartilage was harvested, and a philtral flap was designed with an open approach. Septal and nasal floor mucosae were elevated bilaterally, and a vertical incision was made on the philtrum. A full-thickness flap, including orbicularis oris muscle, was mobilized, and the nasal framework reconstructed with rib cartilage. <i>Evaluations</i>: The SCHNOS questionnaire assessed functional outcomes, while photographic analysis evaluated aesthetic changes. Data were analyzed using SPSS version 24.</p> Results <p><i>Functional Outcome</i>: Significant improvement in the respiratory index (<i>p&#xa0;</i>&lt;&#xa0; .001). <i>Aesthetic Outcome</i>: Significant improvement in the nasal aesthetic index (<i>p&#xa0;</i>&lt;&#xa0;0.001). <i>Photographic Analysis</i>: Significant changes in philtral and columellar lengths, show, and Goode’s ratio.</p> Conclusion <p>The philtral flap method provides promising functional and aesthetic outcomes, with further studies needed to confirm these findings.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>