CC BY-NC 4.0 · Arch Plast Surg 2021; 48(02): 158-164
DOI: 10.5999/aps.2020.01648
Cosmetic
Original Article

Cephalic lateral crural advancement flap

Department of Otorhinolaryngology, Corlu Private Reyap Hospital, Istanbul Rumeli University, Istanbul, Turkey
› Author Affiliations

Background In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.

Methods This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. The LLC was elevated from the vestibular skin using the CLCA flap. A cephalic incision was performed without cephalic trimming. Two independent flaps were formed while preserving the scroll ligament complex. The CLCA flap was advanced onto the lower lateral crus while leaving the scroll area intact. The obtained data were analyzed retrospectively.

Results The mean age of the patients was 31.6 years (range, 20–51 years). The Rhinoplasty Outcome Examination scores after 12 months varied from 90 to100 points, and 93% of patients reported perfect satisfaction. At a 1-year follow-up, the patients’ nasal patency (visual analogue scale) rose from 4.56±1.53 (out of 10) to 9.0±0.65 (P<0.001).

Conclusions The CLCA flap led to better nasal tip definition by protecting the scroll area, increasing tip rotation, and supporting the internal and external nasal valves without cephalic excision.



Publication History

Received: 21 August 2020

Accepted: 28 January 2021

Article published online:
07 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 Nagarkar P, Stark RY, Pezeshk RA. et al. Role of the cephalic trim in modern rhinoplasty. Plast Reconstr Surg 2016; 137: 89-96
  • 2 Patel JC, Fletcher JW, Singer D. et al. An anatomic and histologic analysis of the alar-facial crease and the lateral crus. Ann Plast Surg 2004; 52: 371-4
  • 3 Hatzis GP, Sherry SD, Hogan GM. et al. Observations of the marginal incision and lateral crura alar cartilage asymmetry in rhinoplasty: a fixed cadaver study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 432-7
  • 4 Toriumi DM, Checcone MA. New concepts in nasal tip contouring. Facial Plast Surg Clin North Am 2009; 17: 55-90
  • 5 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109: 2495-505
  • 6 Guyuron B. Alar rim deformities. Plast Reconstr Surg 2001; 107: 856-63
  • 7 Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg 2000; 24: 192-7
  • 8 Constantinides M, Galli SK, Miller PJ. A simple and reliable method of patient evaluation in the surgical treatment of nasal obstruction. Ear Nose Throat J 2002; 81: 734-7
  • 9 Daniel RK. The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 1992; 89: 216-24
  • 10 Gruber RP, Zang A, Mohebali K. Preventing alar retraction by preservation of the lateral crus. Plast Reconstr Surg 2010; 126: 581-8
  • 11 Sazgar AA, Amali A, Peyvasty MN. Value of cephalic part of lateral crus in functional rhinoplasty. Eur Arch Otorhinolaryngol 2016; 273: 4053-59
  • 12 Davis RE. Lateral crural tensioning for refinement of the wide and underprojected nasal tip: rethinking the lateral crural steal. Facial Plast Surg Clin North Am 2015; 23: 23-53
  • 13 Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg 2000; 105: 1820-52
  • 14 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99: 943-52
  • 15 Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 1994; 94: 61-77
  • 16 Gruber RP, Nahai F, Bogdan MA. et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part II. clinical results. Plast Reconstr Surg 2005; 115: 595-606
  • 17 Gubisch W, Eichhorn-Sens J. Overresection of the lower lateral cartilages: a common conceptual mistake with functional and aesthetic consequences. Aesthetic Plast Surg 2009; 33: 6-13
  • 18 Gunter JP, Rohrich RJ. Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg 1992; 90: 821-9
  • 19 Tellioglu AT, Cimen K. Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthetic Plast Surg 2007; 31: 306-10
  • 20 Murakami CS, Barrera JE, Most SP. Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg 2009; 11: 126-8
  • 21 Apaydin F. Lateral crural turn-in flap in functional rhinoplasty. Arch Facial Plast Surg 2012; 14: 93-6
  • 22 Tas S. Superior-based transposition flap: a novel technique in rhinoplasty. Aesthet Surg J 2019; 39: 720-32
  • 23 Daniel RK, Palhazi P. The nasal ligaments and tip support in rhinoplasty: an anatomical study. Aesthet Surg J 2018; 38: 357-68